When a child struggles with attention, planning, or self-control, understanding the cause is not always simple. Parents may notice certain behaviors at home, while a child may perform differently during a structured assessment. This raises an important question: Do different methods of measuring executive functioning tell us the same thing?
A recent study presented at the International Neuropsychological Society conference in Dublin explored this question by comparing three different measures of executive functioning in children being evaluated for Attention-Deficit/Hyperactivity Disorder (ADHD). The findings suggest that looking at executive functioning from more than one perspective may provide valuable information about how a child thinks and functions in everyday life.
What is executive functioning?
Executive functions are mental skills involved in managing our thoughts and behavior. They help us pay attention, plan what we need to do, control our responses, and stay focused on a task. These skills are especially important when evaluating ADHD. However, there is ongoing discussion among neuropsychologists about the best way to measure them. One approach is to ask parents or other people who know the child well about behaviors they observe in everyday life. Another is to directly test a child’s abilities using structured tasks. The study compared both approaches, along with a newer type of assessment that uses virtual reality.
Three different ways to measure executive function
The researchers compared three commonly used assessments: the Behavior Rating Inventory of Executive Function (BRIEF-2), the Cognitive Assessment System (CAS-2), and Nesplora Aula. Although all three are designed to provide information about executive functioning, they collect that information in very different ways.
The BRIEF-2 relies on parent ratings of a child’s behavior. Rather than having the child complete a test, parents report what they observe in everyday situations. The CAS-2 uses more traditional, pencil and paper neuropsychological tasks. In this study, researchers focused on measures of planning and attention. Nesplora Aula takes a different approach. It uses virtual reality-based continuous performance tasks within a simulated classroom environment. Instead of completing paper-and-pencil tasks, the child performs activities in an environment designed to more closely represent a real-life setting. Together, these three approaches allowed the researchers to compare what parents see in daily life with how children perform on traditional and virtual reality-based assessments.
How was the study conducted?
The study included 62 children between the ages of 6 and 16. There were 26 girls and 36 boys, and all participants were evaluated at a community neuropsychology clinic in Scottsdale, Arizona. Each child completed the three assessments as part of their evaluation. The researchers then compared the scores to determine whether performance on one measure was related to performance on another. In simple terms, the researchers wanted to know: When one assessment identifies strengths or difficulties in executive functioning, do the other assessments show something similar?
What did the researchers find?
The results revealed an interesting pattern. Scores from the CAS-2 Planning and Attention composite measures were significantly related to some of the Aula measures, including Attention and Motor composite scores. Several of the individual scores within Aula were also significantly related to one another. These findings provide evidence that the CAS-2 and Aula can identify related aspects of executive functioning even though they use very different testing methods.
The parent rating results told a different story. Different scores within the BRIEF-2 were significantly related to one another. However, the researchers did not find significant relationships between the BRIEF-2 parent ratings and the objective CAS-2 or Aula measures. That does not necessarily mean that one type of assessment is right, and another is wrong. Instead, the findings suggest that they may be providing different kinds of information.
A parent observes a child across many situations and over long periods of time. An objective assessment directly measures how a child performs on specific tasks under structured conditions. These different perspectives may each reveal something important about the child’s executive functioning.
Why do these findings matter?
The results highlight an important point about assessing children with possible executive-function difficulties: one perspective may not tell the whole story. The study found evidence that the CAS-2 and Aula measure similar objective components of executive functioning. At the same time, parent ratings of children’s executive functioning were not significantly related to their performance on the objective assessments. Rather than viewing this difference as a problem, it may help clinicians recognize that each approach captures a different part of a child’s functioning.
For example, an objective test can provide information about how a child performs when asked to complete specific attention, planning, or self-control tasks. Parent ratings can provide another perspective by showing how executive-function challenges appear in the child’s everyday behavior. The researchers suggest that clinicians may therefore want to use both objective testing and parent ratings when evaluating children. Because these methods may measure different aspects of ADHD, both types of information may be useful when developing behavioral and cognitive interventions.
Building a more complete picture
No single assessment can show every part of a child’s daily experience. The findings from this study demonstrate the value of looking at executive functioning through multiple lenses. Traditional testing provides one perspective. Virtual reality-based testing offers another way to directly measure performance in a setting designed to resemble a familiar environment. Parent observations add information about how a child’s skills and difficulties appear outside the testing room.
The study also points to opportunities for additional research. The researchers recommend repeating the study with non-clinical participants and conducting further analysis of the data. For now, the findings offer a useful reminder: different assessment tools do not always have to produce the same results to provide meaningful information. When clinicians bring together objective performance and observations of everyday behavior, they may gain a broader understanding of a child’s executive functioning – and more information to guide the next steps in care.