Sources of data about children's executive functioning: Review and commentary

Accurate measurement of a child's executive functioning (EF) is important for diagnosis, description of functional impairment, and treatment planning. EF assessment typically consists of administration of a battery of performance-based tests involving abilities such as attention, inhibition, reasoning, planning, and mental flexibility. In recent years, observer (e.g., parent) rating scales have been added to the typical EF battery. However, research has revealed that performance-based tests and parent rating scales are not highly correlated. In other words, level of impairment indicated by one source of data often does not match level of impairment indicated by the other source of data. This disagreement places the clinician in a difficult situation when attempting to interpret evaluation results. The profession of pediatric neuropsychology needs to provide guidance about handling this disagreement. Using the current assessment tools, specific EF subdomains may need to be examined systematically to identify precisely where the disagreements lie. Perhaps the relative validity of the two data sources can be determined, and decisions can be made about what to emphasize and what/when to interpret cautiously. Alternatively, perhaps the goal should be to develop and/or refine measurement tools to increase agreement in order to improve accuracy and validity of test interpretation. At this time, the results of performance-based tests and rating scales of EF are being used together but are not being integrated. Evidence-based practice requires that more work be done to enhance the use of these two sources of data.