Executive Function Interventions Research Articles

A review of the literature on childhood executive functions in Zambia

Executive functions development has received a considerable amount of attention in the literature and is known to predict a range of social, cognitive and emotional outcomes in both children and adults; however, little is known about factors that contribute to its development in the Zambian context due to the fragmented literature available in Zambia. A literature review was conducted using five electronic databases (University of Zambia Institutional repository, Google scholar, PubMed, BioMed Central and EBSCO Host) to identify factors that affected executive functions in preschool and primary school children in Zambia. This review established that early childhood education, socio-economic status, physical health, and culture as factors that fall under three categories namely research, environmental and biological affect the development of executive functions among children in Zambia. This review suggests that teachers, caregivers and early childhood stakeholders in Zambia need to pay attention to both environmental and biological factors when designing executive function interventions for preschool children. A focus on improving early childhood education, nutrition, access to good quality health care, intensifying appropriate cognitive stimulating parenting and teaching practices that boost EF in public preschool and primary schools is required

Speech-Language Pathology Interventions for Children With Executive Function Deficits: A Systematic Literature Review.

The purpose of this synthesis was to systematically review the research and guidance for school-based speech-language pathologists (SLPs) who provide intervention to children with developmental executive function (EF) deficits, particularly those children with co-occurring developmental language disorder (DLD). We conducted a structured search of four major electronic databases, as well as a manual review of references and journals, which yielded 4,571 nonduplicate articles. We screened first titles and abstracts and then full texts to identify peer-reviewed articles, dissertations, and theses containing research or guidance for SLPs' interventions for children with co-occurring DLD and EF deficits; this process yielded 27 articles for analysis. We categorized these studies by type of publication and synthesized their contents to assess the evidence base for EF interventions in children with DLD and to evaluate the guidance for SLP-implemented direct and indirect interventions. A small body of research explores the efficacy of SLPs' intervention for children with co-occurring DLD and EF deficits, generally finding modest but inconsistent effects of cognitive interventions and strategy training to improve language outcomes. Meanwhile, nonempirical articles (e.g., tutorials) offer guidance to SLPs to support students with EF deficits through direct and indirect services. A growing body of literature equips SLPs with the principles and strategies of EF intervention. Many of these articles are sourced from literature about children with EF deficits or attention-deficit/hyperactivity disorder, but few empirical studies measure the efficacy of these interventions for children with co-occurring DLD. https://doi.org/10.23641/asha.21401901.

Childhood Executive Functions in Zambia: A Literature Review

Development of executive function has received a considerable amount of attention in the literature and is known to predict a range of social, cognitive, and emotional outcomes in both children and adults. However, little is known about factors that contribute to its development in the Zambian context due to the fragmented literature available in Zambia. A literature review was conducted using five electronic databases (University of Zambia Institutional repository, Google Scholar, PubMed, BioMed Central, and EBSCO Host) to identify factors that affect executive functions in preschool and primary school children in Zambia. This review established that early childhood education, socio-economic status, physical health, and culture as factors that fall under three categories, namely research, environmental, and biological, affect the development of executive functions among children in Zambia. This review suggests that teachers, caregivers, and early childhood stakeholders in Zambia need to pay attention to both environmental and biological factors when designing executive function interventions for preschool children. A focus on improving early childhood education, nutrition, access to good quality health care, and intensifying appropriate cognitive-stimulating parenting and teaching practices that boost EF in public preschools and primary schools is required.

Virtual Reality-based Cognitive Intervention for Enhancing Executive Functions in Community-dwelling Older Adults.

With the rapid growth of the older population globally, it is anticipated that age-related cognitive decline in the prodromal phase and more severe pathological decline will increase. Moreover, currently, no effective treatment options for the disease exist. Thus, early and timely prevention actions are promising and prior strategies to preserve cognitive functions by preventing symptomatology from increasing the age-related deterioration of the functions in healthy older adults. This study aims to develop the virtual reality-based cognitive intervention for enhancing executive functions (EFs) and examine the EFs after training with the virtual reality-based cognitive intervention in community-dwelling older adults. Following inclusion/exclusion criteria, 60 community-dwelling older adults aged 60-69 years were involved in the study and randomly divided into passive control and experimental groups. Eight 60 min virtual reality-based cognitive intervention sessions were held twice a week and lasted for 1 month. The EFs (i.e., inhibition, updating, and shifting) of the participants were assessed by using standardized computerized tasks, i.e., Go/NoGo, forward and backward digit span, and Berg's card sorting tasks. Additionally, a repeated-measure ANCOVA and effect sizes were applied to investigate the effects of the developed intervention. The virtual reality-based intervention significantly improved the EFs of older adults in the experimental group. Specifically, the magnitudes of enhancement were observed for inhibitory as indexed by the response time, F(1) = 6.95, p < .05, ηp2 = .11, updating as represented by the memory span, F(1) = 12.09, p < .01, ηp2 = .18, and the response time, F(1) = 4.46, p = .04, ηp2 = .07, and shifting abilities as indexed by the percentage of correct responses, F(1) = 5.30, p = .03, ηp2 = .09, respectively. The results indicated that the simultaneous combined cognitive-motor control as embedded in the virtual-based intervention is safe and effective in enhancing EFs in older adults without cognitive impairment. Nevertheless, further studies are required to investigate the benefits of these enhancements to motor functions and emotional aspects relating to daily living and the well-being of older populations in communities.

Uncovering Key Elements of an Executive Functioning Intervention in Adolescents: Epilepsy Journey.

The extent to which tailored executive functioning (EF) interventions lead to improvements in other areas of functioning in adolescents with epilepsy is unknown. The types of problems that youth select to practice EF skills during tailored interventions has not been documented. This study aimed to systematically evaluate: 1) the EF problems and strategies selected during a tailored EF intervention for youth with epilepsy, and 2) impact of a tailored intervention on specific problems for subgroups who choose to practice EF skills in those areas. We conducted secondary data analyses of a proof-of-concept clinical trial of a tailored web-based EF intervention for youth with epilepsy. Baseline and 2-months post-intervention questionnaire data were included. A coding system was developed to identify the problem domains that adolescents targeted during treatment. Descriptive statistics and paired sample t-tests were used to examine whether adolescents who identified specific EF problems improved on specific domains. Coding revealed eight domains: Academics, Activities of Daily Living, Family, Social, Adherence, Healthy Habits/Self-care, Sleep, and Emotion/Stress. Significant improvements were noted on "Academics," "Emotion/Stress," and "Sleep" domains for those who applied EF skills to those domains. Tailored EF interventions such as Epilepsy Journey are related not only to improvements in broad EF skills, but also to improvements across areas of functioning that adolescents identify as important. Clinically, EF skills may be more effectively learned when adolescents directly apply EF skills to the problems they identify as most salient. ClinicalTrials.gov: NCT02925663.

Effectiveness of a process-based executive function intervention on arithmetic knowledge of children with Developmental Dyscalculia

BackgroundArithmetic knowledge has long been known as an essential factor for educational and vocational success. Aims: This study aims to explore the effectiveness of a process-based Executive Function (EF) intervention program on the improvement of components of arithmetic. Methods and procedure: A goal-directed sampling method was applied in this study. Participants were assigned into active control and experimental groups. Semi-experimental design with pre-test, post-test and follow-up was utilized in this research. Participants were included in this study based on their WISC-IV and Key-Math test performance. 30 male students aged 8–10 years with a formal diagnosis of Developmental Dyscalculia (DD), selected from a learning disability center in Ahvaz, Iran, participated in the study. The pre-test took 1 month, the intervention including 17 sessions, took two months and the post-test took 1 month. All the students’ arithmetic knowledge were tested in pre-test, post-test, and 3 months after post-test to test the longevity of the intervention effects. Repeated measure Univariate Analysis of Variance was conducted in this study. Outcomes and results: The results indicate that the students who attended the intervention, outperformed control group in the components of factual and procedural arithmetic in post-test and follow-up, however; the performance of two groups in conceptual knowledge was not different. This study contributes to the emerging evidence that EF intervention may improve factual and procedural arithmetic knowledge in children with DD. Conclusions and implications: Process-based EF interventions can improve arithmetic knowledge of students with DD, which can contribute to the literature of this area What this paper adds?The current research helps cognitive science to present a more meticulous theoretical and conceptual pattern for EF components and math, using process-based EF intervention programs with arithmetic content. Furthermore, this research allows for specification of cognitive fundamentals of arithmetic development and understanding the mechanisms underlying the transfer effect of EF intervention to math. The findings of this research can contribute to evidence-based EF intervention studies and help educational psychologists in preparation of appropriate curricula based on the fundamental components of arithmetic development in preschool and primary school.

Executive Function Training for Deaf Children: Impact of a Music Intervention.

Several studies have reported poor executive function (EF) development in deaf children with subsequent impacts on their social and academic attainment. This paper describes the results of a music-based EF intervention designed for deaf children and carried out in two sets of primary schools. This is the first classroom-based EF training study with deaf children, and it also incorporates a replication phase. The intervention was a within-subject crossover design, with 29 deaf children aged 7–11 years who participated in both an EF and an art class control activity, each lasting 10 hours over 5 weeks. Non-verbal EF skills were assessed at pre-test, the crossover point, and post-test. Findings indicated that the EF intervention led to an improvement in participants’ working memory and inhibitory skills in comparison with their performance on the same tasks after the control activity. The findings were not uniform for all EFs targeted nor for all cognitive ability levels in the sample. We discuss the implications of our findings for deaf children with different ability levels and for how EF interventions can be further improved.

Real-world executive functioning for autistic children in school and home settings.

Executive functioning skills are important for children to be able to control thoughts, emotions, and actions, and for their ability to adapt to different settings. Previous studies have found that autistic children have difficulty with executive functioning, but most of these studies took place in the home setting. Executive functioning skills in autistic children have not yet been fully examined in the school setting. This is a knowledge gap that needs to be addressed because the school setting is potentially one of the most demanding in terms of executive functioning and is a setting where executive function interventions are already being used for autistic children. In order to learn more about executive functioning for autistic children in the school setting, this study compared ratings of executive function from autistic children's caregivers and school professionals. The study found that autistic children experience similar but not identical executive function challenges across school and home settings and that supports may differ in each setting. Having information about differences in executive functioning challenges and supports for autistic children across settings can help lead to development of supports that are tailored to each setting.

Developmental Differences in the Relationships Between Sensorimotor and Executive Functions.

BackgroundThere is evidence that sensorimotor and executive functions are inherently intertwined, but that the relationship between these functions differ depending on an individual’s stage in development (e.g., childhood, adolescence, adulthood).ObjectiveIn this study, sensorimotor and executive function performance was examined in a group of children (n = 40; 8–12 years), adolescents (n = 39; 13–17 years), and young adults (n = 83; 18–24 years) to investigate maturation of these functions, and how the relationships between these functions differ between groups.ResultsAdults and adolescents outperformed children on all sensorimotor and executive functions. Adults and adolescents exhibited similar levels of executive functioning, but adults outperformed adolescents on two sensorimotor functioning measures (eye-hand coordination spatial precision and proprioceptive variability). Regression analysis demonstrated that executive functions contribute to children’s sensorimotor performance, but do not contribute to adolescent’s sensorimotor performance.ConclusionThese findings highlight the key role that developmental stage plays in the relationship between sensorimotor and executive functions. Specifically, executive functions appear to contribute to more successful sensorimotor function performance in childhood, but not during adolescence. It is likely that sensorimotor functions begin to develop independently from executive functions during adolescence, and therefore do not contribute to successful sensorimotor performance. The change in the relationship between sensorimotor and executive functions is important to take into consideration when developing sensorimotor and executive function interventions.

Comprehensive attention training system (CATS): A computerized executive-functioning training for school-aged children with autism spectrum disorder

Objective Theory suggests that impaired executive functioning (EF) might explain several symptoms of autism spectrum disorder (ASD) in children. However, only a few studies have examined the efficacy of EF training for the children using randomized control trial designs, and only two of them found significant benefits of the training. Method We designed Comprehensive Attention Training System (CATS), and tested this new EF intervention for children with ASD in a small-sampled randomized controlled trial. Twenty-five children with ASD aged six to twelve were randomly assigned to either the CATS or the control training and were assessed pre- and post-training. Results Relative to the control group, the CATS group improved on EF as measured by the trail-making test, avoiding perseverative errors, and forming conceptual responses in the Wisconsin Card Sorting Task. There were also indications that CATS contributed to long-term communication skills as measured by the Vineland adaptive behavior scales. Conclusions We report preliminary evidence that the CATS intervention may improve the EF of school-aged children with ASD compared to a control intervention. We discuss the results in terms of their generalizability to other developmental disorders.

JPP Student Journal Club Commentary: Executive Functioning Intervention in Epilepsy: Implications for Other Pediatric Chronic Health Conditions.

JPP Student Journal Club Commentary: Executive Functioning Intervention in Epilepsy: Implications for Other Pediatric Chronic Health Conditions.

Pilot Executive Functioning Intervention in Epilepsy: Behavioral and Quality of Life Outcomes.

To examine changes in emotional and behavioral functioning and health-related quality of life (HRQOL) following a web-based executive functioning (EF) intervention open pilot trial (e.g., Epilepsy Journey) for adolescents with epilepsy. Adolescents with an established diagnosis of epilepsy, EF deficits, and without developmental disorders participated in a single-arm trial of Epilepsy Journey. Epilepsy Journey is a gamified, online learning environment comprised of 10 learning modules targeting EF deficits (e.g., working memory, organization) and tailored to epilepsy with accompanying telehealth problem-solving sessions. Adolescents completed questionnaires assessing emotional and behavioral functioning and HRQOL at baseline, posttreatment, and 2 follow-ups . Longitudinal mixed models and logistic regression analyses were used for these secondary analyses. 39 adolescents were recruited for Epilepsy Journey (Mage=15.3 years; 67% female; 87% White: Non-Hispanic; 39% experienced seizures in the past 3 months). Preliminary data indicate significant improvements in caregiver-reported Externalizing symptoms, Behavioral Symptom Index scores and Adaptive Skills from baseline to 5-month follow-up. Significant improvements were observed for caregiver-reported Mood/Behavior and self-reported Impact, Cognitive Functioning, Executive Functioning, and Sleep subscales of the PedsQL Epilepsy Module. Clinically significant improvements (e.g., clinical/at-risk to normative levels) in behavioral and quality of life domains were also noted. Epilepsy Journey appears to contribute to changes in emotional and behavioral functioning and HRQOL in adolescents with epilepsy. Given the proof of concept trial format of this study, an important future direction is to conduct a randomized controlled trial with a larger, generalizable cohort of adolescents with epilepsy.

Inhibitory control training in healthy and highly educated older adults.

ABSTRACT.Executive function training is considered a promising tool for delaying the natural effects of aging on cognition. However, there are still few studies that propose a unimodal intervention with a focus on inhibitory control, and none of them has studied the effect of this type of intervention on older adults (OA).Objective:The aim of this study is to investigate the benefits of inhibitory control training in healthy OA by comparing the two assessment time points, namely, before and after training.Methods:Twenty-seven participants were included after interview and checking the inclusion criteria. The training was based on the stop-signal paradigm and carried out in 21 sessions.Results:Participants performed better after training by reducing the false alarm error rate (i.e., for stop-signal trials), reducing omission error rate, showing an increase in hit rate, Go response time (i.e., for go-signal trials), stop-signal response time, and showing a decrease in the level of anxiety. The executive function training had no significant impact on the scores obtained in the complementary neuropsychological tests.Conclusions:These results are consistent with previous studies that support the viability and effectiveness of cognitive intervention for executive functions in OA and suggest a positive effect of the intervention, which may be related to the learning experience of a new and challenging task.

Near- and far-transfer effects of an executive function intervention for 2nd to 5th-grade struggling readers

This study assessed the impact of a teacher-delivered, small-group reading-specific executive function (EF) intervention on reading performance in a sample of 57 teacher-identified struggling readers, ranging in age from 7;6 to 12;3 (Mage = 9;10) in 2nd to 5th grades at a public elementary school in the Mid-Atlantic United States. Near-transfer effects of EF interventions are more common than far-transfer to academic skills. Thus, we assessed near- and far-transfer effects for intervention (n = 29) and control (n = 28) children. The reading-specific EF intervention produced medium to large effects on reading-specific and domain-general EF skills as well as on researcher-administered and school-administered reading comprehension measures, even after grade level (and thus reading teacher), verbal ability, children’s age, and respective pretest scores were controlled. These findings underscore the importance of translational work that takes researcher-tested interventions into real-world contexts to support children’s development. Implications of findings for practice are discussed.

Feasibility and potential benefits of an attention and executive function intervention on metacognition in a mixed pediatric sample

The term “metacognition” describes thinking about a cognitive phenomenon or, more simply put, thinking about thinking . Metacognition involves using knowledge about one’s cognitive processes to change behavior, including monitoring and controlling cognition. Metacognition is vital for learning and is often more difficult for children with neurodevelopmental concerns (e.g. Attention Deficit Hyperactivity Disorder [ADHD], Fetal Alcohol Spectrum Disorder [FASD], Autism Spectrum Disorders [ASD]), possibly due to underlying deficits in attention and executive functioning (EF). The present study evaluated a 6- to 8-week cognitive intervention aimed at improving attention and EF and children’s metacognitive abilities. Participants included a mixed sample of 50 children ages 6–12 years presenting with attention and/or EF deficits. Children within the active intervention group completed a game-based attention/EF intervention called Caribbean Quest (CQ), which combines process-specific and compensatory approaches to remediate attention and EF. Educational Assistants (EAs) supported children during gameplay by teaching explicit metacognitive strategies. Pre/post assessments included measures of attention and working memory (WM), metacognitive awareness (child, parent, and EA questionnaires), and metacognitive regulation (metacognitive monitoring and control). Results indicated post-intervention gains in WM, metacognitive awareness, and metacognitive regulation (self-monitoring and metacognitive control). These results provide preliminary support for CQ as potentially beneficial in improving aspects of EF and metacognition in children.

Adaptation and Implementation of an ASD Executive Functioning Intervention in Children's Mental Health Services

Adaptation and Implementation of an ASD Executive Functioning Intervention in Children's Mental Health Services

Self-Management Intervention for Attention and Executive Functions Using Equine-Assisted Occupational Therapy Among Children Aged 6-14 Diagnosed with Attention Deficit/Hyperactivity Disorder.

Background: Attention deficit/hyperactivity disorder (ADHD), characterized by inattention, hyperactivity, and impulsivity, is currently one of the most common diagnoses given to children. Children with ADHD have a unique cognitive profile that involves difficulties in executive functions (EFs) and in the self-management system of the brain, and are at higher risk for educational failure, social and emotional difficulties, and high risk behavior. Objectives: The purpose of this study was to examine the effectiveness of self-management intervention for attention and executive functions using equine-assisted occupational therapy (STABLE-OT) for school-aged children with ADHD. Design: A pre-post design was used in the intervention. Setting/location: The study was conducted at two riding school stables is Israel. Subjects: Twenty-five 6-14-year-old children (3 girls, 22 boys, age: 7.8-12.3 years, M = 9.41 ± 1.75) diagnosed with ADHD participated in a therapeutic equestrian riding intervention. Intervention: The intervention included structured 45-min sessions for 12 weeks, while integrating child- and family-centered strategy acquisition and immediate feedback principles. Outcome measures: Their EF and occupational performance were evaluated pre- and post-intervention, using The Behavior Rating Inventory of Executive Function (BRIEF) and the Canadian Occupational Performance Measure (COPM). Results: Results showed a significant improvement in EF, as reflected by statistically significant decreases in the Global Executive Composite (GEC; t = 2.801; p = 0.01), metacognitive index (t = 3.873; p = 0.001), working memory (t = 2.476; p = 0.021), monitor (t = 2.359; p = 0.027), and initiation (t = 3.204; p = 0.004) subscales of the BRIEF questionnaire. A statistically (p < 0.001) and clinically significant improvement was also found in the COPM performance and satisfaction scales. Conclusions: This study provides key preliminary evidence supporting the effectiveness of an individual equine-assisted OT intervention for children with ADHD. It constitutes an initial step toward clinical implementation of such therapeutic approaches, and is expected to spark further research in this area.

Examining Longitudinal Associations between Externalizing and Internalizing Behavior Problems at Within- and Between-Child Levels.

Externalizing and internalizing behavior problems are known to often co-occur, but mechanisms underlying this co-occurrence remain unclear: whether the associations are due to causal influences of one domain on the other or due to common risk processes influencing both domains. This study aimed to better understand the sources of co-occurring behavior problems by disentangling within- and between-child levels of associations between the two across the five years of childhood, from pre-kindergarten to Grade 3. We analyzed a longitudinal sample of 1060 children from non-urban settings in the U.S. using random-intercept cross-lagged panel models (RI-CLPMs) as an alternative to the commonly-used standard CLPMs. Results indicate that co-occurring externalizing and internalizing problems can be explained partly by a unidirectional influence from externalizing to internalizing problems operating within children and partly by stable differences between children that influence both domains of problems. Further analyses indicate that an executive function deficit in early childhood is an important shared risk factor for both problems, suggesting the utility of executive function interventions in preventing or addressing externalizing and internalizing problems in childhood.

외상성 뇌손상 환자의 관리기능 중재에 관한 체계적 고찰

본 연구는 체계적 고찰을 통해 외상성 뇌손상 환자의 관리기능 중재에 대한 특성과 효과를 분석하고자 시행되었다. 한국보건의료연구원 지침에 따라 체계적 고찰을 시행하였고, 검색 데이터베이스는 PubMed, Embase, 한국학술정보, 한국교육학술정보원, 누리미디어를 사용하였으며 2010년 1월부터 2019년 5월까지 출간된 연구를 분석하였다. 총 1,345편의 연구가 검색되었으며, 선정기준에 따라 8편의 연구가 최종 분석에 포함되었다. 문헌의 질 평가는 코크란의 RoB(risk of bias) 도구를 사용하였다. 분석된 연구는 모두 무작위 대조군 실험연구로써 근거수준은 Ⅰ에 해당한다. 관리기능 평가도구는 8편의 연구에서 17개가 사용되었으며, 그 중 D-KEFS(Delis-Kaplan Executive Functioning System), TMT(Trail Making Test)가 주로 사용되었다. 관리기능 중재는 한국형 전산화인지재활프로그램(CoTras), 상호 작용식 메트로놈, 웹기반 인지훈련용 재활게임(CogniFit), 가상현실 슈퍼마켓(Virtual Mall), 작업기반 전략훈련, SMART, CogSMART, STEP 프로그램이 적용되었다. CogniFit을 제외한 대부분의 중재방법이 관리기능 혹은 일상생활 참여 향상에 효과적이었다. 본 연구는 외상성 뇌손상 환자에 대한 관리기능 중재의 종류, 적용방법 및 효과성을 체계적으로 보고하여 임상적 근거를 제시하였다. 따라서 인지재활전문가인 작업치료사가 근거기반 실행을 통해 효과적인 중재접근을 클라이언트에게 적용하기를 기대한다.

A Review of Language, Executive Function, and Intervention in Autism Spectrum Disorder.

Difficulties with both executive functions and language skills are common but variable in autism spectrum disorder (ASD). Executive functions and language skills are related to one another, such that vocabulary, syntax, and pragmatics are related to domains of working memory, shifting, and inhibition in ASD, although the directionality of these relationships remains unclear. Moreover, interventions that target pragmatic ability have been found to improve executive function skills, and conversely, executive function interventions are linked with improvements in social skills in children with ASD. We review the literature on executive functions, language skills, and their relationship in ASD; discuss factors that may be driving inconsistent findings; and explore clinical applications from the research thus far.