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The Executive Function Challenge Task (EFCT): Development of a Lab-Based Observational Measure for Flexibility and Planning in Children with ASD
Parents, teachers and clinicians of children with ASD have observed cognitive and behavioral flexibility and planning deficits that inhibit the child’s ability to socialize and complete every day tasks. Recent reviews of the literature revealed that it is very difficult to capture these observed executive functioning (EF) deficits with laboratory measures. To date, an observational measure that is sensitive to core EF difficulties and capable of tracking improvements in children with ASD has not been developed.
Objectives:
Design an ecologically-valid, well-controlled observational measure that captures difficulties, strengths and change in EF, particularly flexibility and planning, in verbal children with ASD.
Methods:
Sixty-two children with ASD ages 8-12 (Mean=10.31,SD=1.0) without ID (IQ>70) participated in the study. Fifty-five of the children were males (88.7%) and were: Asian 16.1%, Black 11.3%, Hawaiian/Pacific Islander 3.2%, White 64.5% and Other 4.8%. The data were collected as part of a comparative effectiveness treatment study.
The EFCT is a 30-minute interview that challenges children to be flexible and planful in the context of five activities. Each task is standardized with specific verbal instructions that are provided by the examiner and explicit guidance about what prompts can be given in response to the child’s actions. Scoring criteria are also standardized. Specific challenges to the child’s flexibility and planning are introduced in each task (e.g. in one task the child is told that the time is up and they have to clean up a puzzle before it has been completed, in another the child is asked to explain the steps he/she will take to make a clay sculpture).
The EFCT yields average Flexibility and Planning scores and an overall rating of Social Appropriateness. Examiners achieved inter-rater agreement >90%. Scores on the EFCT were compared to lab measures completed by a different examiner (subtests on the Wechsler Abbreviated Scale Intelligence (WASI), the ADOS Restricted/Repetitive Behaviors/Interests (RRBI), Delis Kaplan Executive Function Scale Category Fluency/Switch Contrast score (DKEFS)), parent report measures (Behavior Rating Inventory of Executive Functions, a longer EF questionnaire, Social Responsiveness Scale) and classroom observations.
Results:
EFCT Flexibility correlates with WASI Block Design (r=-.387,p<.01), ADOS RRBI (r=.277,p=.03), DKEFS (r=-.261,p<.05), parent report of EF problems (r=.296, p=.05), and amount of interference from EF problems (r=.281,p=.03). EFCT Planning correlates with WASI Block Design (r=-.318,p=.01), WASI Similarities (r=-.280,p=.03), and Following Rules in the classroom observation (r=.272,p=.03). EFCT Social relates only to parent report of EF problems (r=-.391,p=.01). The EFCT has also been demonstrated to be sensitive to treatment effects (Kenworthy and Anthony et al., in press).
Conclusions:
Our findings suggest that the EFCT is sensitive to difficulties, strengths and change in EF skills. As there are some relationships with both lab-based and “real world” measures, we see the EFCT as a potential bridge between these methodologies to accurately measure change in core EF deficits over time in an ecologically-valid measure. The relationships presented here, though significant, are not large effects, suggesting that the EFCT is capturing a unique set of behaviors that could be important in future treatment research efforts.
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