Executive Functions as Outcome Measure In Adults with Pervasive Developmental Disorders: An Italian Experience with BRIEF-A After 1 Year of Farm-Community Intervention

Background:  

Individuals with Pervasive Developmental Disorders (PDD) commonly show deficits in many neuropsychological measures and the executive dysfunction is thought to be primary to autism. Appropriate assessment of these complex functions is critical to develop necessary interventions and it represents a challenge to our traditional methodologies. Ecological validity has become an important focus in neuropsychological assessment with particular relevance for the executive functions (EF), which coordinate one's cognitive and behavioral capacities with real-world demand situations. The Behavior Rating Inventory of Executive Function-Adult version (BRIEF-A) was developed to capture the real-world behavioral manifestations of executive dysfunctions. It's composed of nine theoretically and empirically derived clinical scales that measure various aspects of executive functioning (EF): Inhibit; Self-Monitor; Plan/Organize; Shift; Initiate; Task Monitor; Emotional Control; Working Memory; Organization of Materials.

Objectives:

To study the EF pre and post Farm-Community intervention in adults with PDD in everyday environment through BRIEF-A.

Methods:

We examined intra-group differences in executive functioning of 17 adults men with PDD (mean age: 24, 80; ds: 7,78; range: 15,1-42,7) diagnosed with ICD-10. Executive Functioning at baseline (T0) and after 1 year (T1) from the Farm-Community intervention using BRIEF-A was evaluated. T-test was used for statistic data analysis (p<.005 was established as significant).

Results:  

T-tests revealed significant differences in the follows scales: Emotional Control (T0: mean T score = 56,11; T1: mean T score = 50,29; p = .003); Working Memory (T0: mean T score = 74,94; T1: mean T score = 66,70; p = .005) and Plan/Organise (T0: mean T score = 74,88; T1: mean T score = 66,82; p = .005). Further, there were also significant differences in Behavioral Regulation (T0: mean T score = 60,47; T1: mean T score = 54,29; p = .000o significant differences were found in the Self-Monitor (p = .010); Initiate (p = .140); Task Monitor (p = .007); and Organisation of Materials (p = .084) scales.) and Metacognition (T0: mean T score = 71; T1: mean T score = 63,70; p = .005) indexes and in the Global Executive Composite (T0: mean T score = 67,35; T1: mean T score = 60,17; p = .000 In contrast, n).

Conclusions:   

Data indicate that after 1 year of Farm-Community intervention, individuals obtained a positive outcome in many executive functions studied. Particularly, in Metacognition index and Global Executive Composite they pass from a clinically elevated scores (defined as a T score ≥ 65) to underclinical cutoff. Working Memory and Plan/Organize scales were impaired at T0 and these data were confirmed also at T1 but with lower scores. Emotional Control scale and Behavioral Regulation index were no impaired at baseline and this trend continues at T1. Further, findings indicate that the BRIEF-A is sensitive to subtle executive changes in adults with PDD. Current study also calls attention to the ecological assessments of neuropsychological profiles in fact the novelty of BRIEF-A is that it is focused on EF in everyday environment.To conclude we suggest the opportunity to use BRIEF-A as outcome measure in clinical settings for adults with PDD.