Recently I’ve purchased the Executive Functions Test-Elementary (EFT-E) by Linguisystems and used it with a few clients in my private practice and outpatient hospital-based school program. The EFT-E is a test of language skills that affect executive functions of working memory, problem solving, inferring, predicting outcomes, and shifting tasks. For those of you not familiar with executive functions (EFs), they are higher level cognitive processes involved in inhibition of thought, action and emotion, which are located in the prefrontal cortex of the frontal lobe of the brain.
The development of executive functions begins in early infancy but it can be easily disrupted by a number of adverse environmental and organic experiences (e.g., psycho-social deprivation, trauma, etc). Any child whose typical prenatal, perinatal or postnatal development was disrupted by toxins, illnesses, injuries, or any form of life adversity is considered at-risk for executive function impairment. These include but not limited to the following:
- Genetic Disorders
- Down Syndrome
- Fragile X Syndrome
- Medical Conditions
- Cardiac Disorders
- Metabolic Disorders
- Respiratory Disorders
- Immunological Disorders
- Digestive Disorders
- Brain Injury
- Acquired (TBI)
- Surgical Intervention (Tumor removal)
- Psychiatric Conditions
- Attention and Behavior Disorders
- Autism Spectrum Disorders
- Anxiety Disorder
- Mood Disorder
- Reactive Attachment Disorder
- Parental Substance Abuse
- Fetal Alcohol Spectrum, Static Encephalopathy, etc
- Acquired Syndromes
- Cerebral Palsy
- Orphanage, Foster care
- Sexual, physical abuse, neglect, etc.
- Attention and Immediate Memory – Auditory subtest requires the child to pay attention to details from short passages & answer 3 follow-up questions.
- Targeted skills: attention to details, vocabulary knowledge and use, working memory (immediate retention and manipulation of presented concepts), use of prior knowledge to answer questions, coherent, cohesive, relevant and targeted responses.
- Attention and Immediate Memory – Auditory and Visual subtest requires the child to answer questions about what they’ve heard and seen in the pictures.
- Targeted skills: attention to details, inferencing, context clue comprehension, recall of information, response inhibition
- Working Memory and Flexible Thinking subtest requires the child to generate novel responses and answer 2 critical thinking questions based on short passages
- Targeted skills: attention to details, use of prior knowledge to answer questions, flexible thinking, problem solving, provision of relevant vs. vague solutions, inferencing, self-regulation and self-talk, inhibition of irrelevant responses
- Shifting subtest requires the child to quickly and accurately shift their thinking by naming a member of a related category after they hear 4 items in a related category e.g., “Add, subtract, multiply and divide are math words. Now tell me a grammar word”)
- Targeted skills: vocabulary knowledge, attention to details, immediate and long term memory, categorization abilities, set-shifting, irrelevant response inhibition.
As you can see based on subtest breakdown, EFT-E strongly focuses on assessment of memory, vocabulary as well as coherent response formulation. While these are excellent skills to focus on since they are strongly correlated with student success in academic setting, it is also very important to understand that NOT all the executive function abilities are targeted by the EFT-E. For example the EFT-E doesn’t contain any time measured tasks, visual-motor flexible thinking sequencing tasks, verbal fluency tasks, inhibition of dominant and automatic verbal responses, spatial planning, rule learning, as well as inhibition of impulsive and perseverative responses, just to name as few. So if you want a student to undergo a complete executive function assessment battery then a recommendation for a in depth neuropsychological assessment is an order.
However, when it comes to assessment of language pertaining to executive functions, the EFT-E does have a number of advantages.
What I like about this test:
This test allows me to identify subtle language based difficulties in higher functioning children referred for language assessment. The test also allows me to identify students with weaknesses in the following areas:
- Vocabulary knowledge and use
- Memory (long-term, short-term and working memory)
- Sustained attention
- Discourse formulation
- Inferencing and problem solving (ineffective solutions)
- Recall of key information in text and messages
- Self -regulation
- Context-clue identification
- Social pragmatics (e.g., flexible thinking)
A word of caution regarding testing eligibility:
The EFT-E is not for everyone. As mentioned before I would only administer this test to higher functioning students undergoing language assessment for the first time or to higher functioning students receiving a re-evaluation, who have previously passed tests of problem solving and/or social language development such as TOPS-3 or SLDT-E, who may need the EFT-E to determine continued eligibility for services.
I would not administer this test to the following populations:
- Students with intellectual disabilities
- Students with severe language impairment and limited vocabulary inventories
- Students with significant memory and language processing deficits
- English Language Learners (ELL) with suspected language deficits (pg 34 of the manual specifically states that children with Limited English Proficiency were excluded from the standardization sample)*
- Students from low SES backgrounds*
*I would not administer the EFT-E to the latter two groups of students due to significantly increased potential for linguistic and cultural bias stemming from lack of previous knowledge and exposure to popular culture as well as vocabulary concepts (The EFT-E is a very heavily vocabulary laden test with words such as pesticides, Haiku, Incas, “double-dribbled, “traveled”, “free throws”, symmetry, archery, lanyards, abolish, onomatopoeia, etc).
Have YOU purchased EFT-E yet? If so how do you like using it? Post your comments, impressions and questions below.
Helpful Resources Related to Executive Functions Overview, Assessment and Remediation:
- The Role of Frontal Lobe in Speech and Language Functions
- Executive Function Impairments and At Risk Pediatric Populations
- Differential Diagnosis of ADHD in Speech Language Pathology
- Behavior Management Strategies for Speech Language Pathologists
- Fetal Alcohol Spectrum Disorder An Overview of Deficits
- Speech Language Assessment and Treatment of Children with Alcohol Related Disorders