Executive functioning: a scoping review of the occupational therapy literature

Implementation of information and communication technology to facilitate participation in high school occupations for students with neurodevelopmental disorders

PURPOSE

Information and communication technology (ICT) has been proposed to enable an inclusive learning environment and increased participation for students with special educational needs. The aim of this study was to investigate the perceived need for ICT before and after an individualized ICT intervention among high school students with neurodevelopmental disorders and describe how the ICT was used to improve participation in school activities.

MATERIALS AND METHODS

This mixed-method study, with a one-group pre- and post-test design, included 99 high school students with neurodevelopmental disorders. Data from questionnaires and assessments using the School Setting Interview (SSI) were analyzed using descriptive statistics and the Wilcoxon signed-rank test. Deductive content analysis was performed on written notes in the SSI assessment.

RESULTS

The results showed that students' median number of perceived needs for ICT in school activities had decreased from six needs at baseline to one need at follow-up (t16.5 df(98), p<.001). There were five SSI items for which over 50% of the students perceived a need for ICT, with most students (95%) needing support in the item Remember things. Students received a laptop, tablet or smartphone (95%), software for planning or structure (84%) and ICT for writing and reading (66%). The ICT facilitated participation in multiple school activities, providing reminders and structure, facilitating notetaking and improving spelling. After the ICT intervention, students (61%) experienced improved study results and improved ability to manage difficult school situations (68%).

CONCLUSION

To conclude, an individualized ICT intervention as support to increase school participation is promising among high school students with neurodevelopmental disorders.

Babycare Assistance Needs of Parents With Physical Disabilities: An Observational Study

The assistance needs of parents with physical disabilities have been widely underexamined. This qualitative observational study described the assistance needs of parents with physical disabilities during the performance of in-home babycare activities. Thirty-one parents were assessed by trained occupational therapists using the Activities of Daily Living (ADL) Profile adapted for use with parents, an ecological performance-based assessment that considers executive functioning. Descriptive statistics of participants' demographics and parents' independence scores in babycare activities were calculated, and a qualitative content analysis of parents' assistance needs was performed using video recordings. At least one-fourth of parents experienced difficulties in all babycare activities, either affecting activity performance or requiring verbal or physical assistance. Assistance needs were also observed in all activity-related operations of the ADL Profile. It is necessary to develop specialized clinical services to address assistance needs and promote safe and easy parenting in parents with physical disabilities.

The relationship between executive function and activities of daily living in children with specific learning disorders

This study explores the relationship between executive functions (EF) and activities of daily living in children with specific learning disorder (SLD). Thirty SLD children (14 females and 16 males) and thirty typically developing (TD) children (13 females and 17 males) aged 8 to 11 years were selected from learning disabilities schools and centers as well as public schools in Tehran, Iran. The mean age for the TD group was 9.67 ± 0.82 and for the SLD group was 9.5 ± 0.5. Basic Activities of Daily Living (B-ADL) and Instrumental Activities of Daily Living (IADLs) were assessed using the Modified Barthel questionnaire and the Lawton scale, respectively. Executive function was evaluated using the Parent Form of Behavior Rating Inventory of Executive Function (BRIEF) questionnaire. Pearson correlations were utilized to determine the correlation between the average score of "executive function" and "daily life activities". Results indicated that children with SLD scored significantly lower in EFs compared to TD children. Although there was no significant difference in B-ADL between the two groups, children with SLD scored lower in IADL. This study sheds light on the impact of EF on the ability of children with SLD to complete daily living activities. Further research is needed to better understand and address these challenges.

Efficacy of Occupational Performance Coaching with and without Four Quadrant Model of Facilitated Learning for mothers of children with specific learning disorder: Study protocol for a randomized controlled trial

Background

In addition to academic problems, children with a specific learning disability (SLD) encounter problems with participation in activities outside school.

Purpose

To investigate the efficacy of Occupational Performance Coaching (OPC) with and without Four Quadrant Model of Facilitated Learning (4QM) in the mothers of children with SLD.

Method

A single-blinded, parallel-group randomized clinical trial will be carried out. Mothers of children with SLD will constitute the participants and be allocated to experimental (OPC+4QM) and control (OPC alone) groups.

Key issues

Children's occupational performance and satisfaction, participation in activities outside school, goals attainment, executive function, and academic achievement along with self-efficacy of mothers will be measured in baseline, post-intervention, and one-month follow-up stages.

Implications

An OPC intervention protocol may improve children's participation in activities outside school and may help clarify whether 4QM promotes maternal empowerment and better results for children with SLD.

Trial registration

Clinical Trials, IRCT20140416017301N9. (https://en.irct.ir/trial/55842)

Effect of Occupation Performance Coaching with Four-Quadrant Model of Facilitated Learning on Children with Specific Learning Disorder

Background

Children with a specific learning disability (SLD) have deficits in everyday occupations along with executive function in addition to academic issues.

Objective

The present study is aimed at investigating the effectiveness of Occupational Performance Coaching (OPC) and the Four-Quadrant Model of Facilitated Learning (4QM) interventions on the participation in occupational performance and executive function skills in children with SLD.

Method

This study was a single-case experimental design (multiple baselines) in which six children with SLD were randomly assigned to three groups. In the baseline phase, three groups of children underwent repeated executive function assessments using the Stroop Color and Word Test (SCWT) and the Wisconsin Card Sorting Test (WCST) in the multiple baselines. In the intervention phase, all six mothers of children with SLD individually received OPC and 4QM interventions once a week for 14 sessions of 60 minutes and during this period, children were evaluated six more times for executive function skills according to SCWT and WCST. In addition, The Canadian Occupational Performance Measure (COPM) and Behavior Rating Inventory of Executive Function (BRIEF) at the beginning and the end of the baseline phase and the end of the intervention phase were completed by mothers of children with SLD.

Results

More than 50% PND of the SCWT and WCST in the visual analysis graph's information along with significant changes in COPM scores and large effect size of BRIEF subscales (Cohen's d ≥ 0.8) in pre- and postintervention showed the effectiveness of OPC and 4QM on the participation in occupational performance and executive function skills in children with SLD.

Conclusion

The results of the study support the effectiveness of OPC and 4QM interventions on children with SLD. However, research with more participants and experimental methods can provide further evidence.

Automaticity and Executive Abilities in Developmental Dyslexia: A Theoretical Review

Cognitive difficulties are well documented in developmental dyslexia but they present a challenge to dyslexia theory. In this paper, the Model of the Control of Action is proposed as a theoretical explanation of how and why deficits in both automaticity and executive abilities are apparent in the cognitive profiles of dyslexia and how these deficits might relate to literacy difficulties. This theoretical perspective is used to consider evidence from different cognitive domains. The neuroanatomical underpinnings of automaticity and executive abilities are then discussed in relation to the understanding of dyslexia. Links between reading, writing, and executive function are considered. The reviewed evidence suggests that dyslexia theory should consider an interaction between procedural learned behaviour (automaticity) and higher-order (executive) abilities. The capacity to handle environmental interference, develop and engage adaptive strategies accordingly, and plan actions all require interactions between the cerebellum and the prefrontal cortex (PFC). Difficulties in these areas might explain both impairments in the cumulative development of literacy skills in childhood and general task management in everyday life in adulthood. It is suggested that improved measures are required to assess this cerebellar–PFC interaction and to allow early identification of future literacy difficulties, allowing implementation of timely interventions and reasonable adjustments.

The relations between executive functions and occupational functioning in individuals with bipolar disorder: a scoping review

Background

Patients with bipolar disorder experience impairments in their occupational functioning, despite remission of symptoms. Previous research has shown that neurocognitive deficits, especially deficits in executive functions, may persist during euthymia and are associated with diminished occupational functioning.

Objectives

The aim of this scoping review was to identify published studies that report on the relationships between executive functions and occupational functioning in BD to review current knowledge and identify knowledge gaps. In addition to traditional neuropsychological approaches, we aimed to describe executive functioning from a self-regulation perspective, including emotion regulation.

Methods

We applied the methodological framework as described by Arksey and O’Malley (Int J Soc Res Methodol Theory Pract 8:19–32, 2005) and Levac et al. (Implement Sci 5:1–9, 2010). We searched PubMed and psycINFO for literature up to November 2021, after which we screened papers based on inclusion criteria. Two reviewers independently performed the screening process, data charting process, and synthesis of results.

Results

The search yielded 1202 references after deduplication, of which 222 remained after initial screening. The screening and inclusion process yielded 82 eligible papers in which relationships between executive functions and occupational functioning are examined.

Conclusion

Neurocognitive deficits, including in executive functions and self-regulation, are associated with and predictive of diminished occupational functioning. Definitions and measurements for neurocognitive functions and occupational functioning differ greatly between studies, which complicates comparisons. Studies on functional remediation show promising results for improving occupational functioning in patients with BD. In research and clinical practice more attention is needed towards the quality of work functioning and the various contexts in which patients with BD experience deficits.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40345-022-00255-7.

Evaluation of executive functions and everyday life for people with severe mental illness: A systematic review

•Assessment tools have progressed from measuring specific components, to more comprehensive assessments.•Performance-based tools, has the potential to include an EF index as part of the test scoring.•Most researchers either chose short versions of the assessment tools to address the subjects' attentional capacities.•Using more than one evaluation method enabled to draw a more precise picture of the function.

Cognitive Function in Cardiac Patients: Exploring the Occupational Therapy Role in Lifestyle Medicine

Patients with cardiac dysfunction are at increased risk of mild cognitive impairment, which can affect their ability to successfully engage in daily activities important for home and community safety and in maintaining health and well-being. This risk increases in accordance with the number of cardiac conditions and cardiovascular risk factors or comorbidities. Occupational therapy has a role in chronic disease management in assessing and improving functional abilities affected by physical, emotional, and cognitive domains. With a holistic and client-centered approach, occupational therapy can complement lifestyle medicine principles through promotion and enablement of engagement in purposeful activity and self-management practices. It is suggested that the clinical management of patients with cardiac dysfunction expands beyond the traditional physical aspects of care to encompass cognitive considerations and incorporate occupational therapy in practice.

Participation in Peer-Play Activities Among Children With Specific Learning Disability: A Randomized Controlled Trial

OBJECTIVE

Children with a specific learning disability (SLD) have deficits in social and academic competence and executive function (EF). In this study, we used the Model of Human Occupation to investigate the effect of peer-play activities on occupational values and competence as well as EF skills (i.e., behavior regulation and metacognition) in children with SLD.

METHOD

Forty-nine children ages 7-11 yr with SLD were randomly assigned to the peer-play and control groups. Outcome measures were the Behavior Rating Inventory of Executive Function and the Child Occupational Self-Assessment (COSA).

RESULTS

Data analysis showed that the effects of the intervention on EF skills were medium to large. The occupational values and competence did not change according to the COSA.

CONCLUSION

Occupational therapy practitioners can use peer-play activities to enhance EF in children with SLD; however, perceived occupational values and competence may not show any changes with the peer-play intervention using a self-assessment instrument.

Adult Age and Cultural Differences in Performance on the Weekly Calendar Planning Activity (WCPA)

OBJECTIVE. We compared performance on a cognitively demanding task, the Weekly Calendar Planning Activity, of participants in three age groups and two countries (United States and Israel).

METHOD. A sample of 375 U.S. and 433 Israeli healthy adults participated. During the activity, participants were observed for speed, accuracy, strategy use, and efficiency.

RESULTS. Accuracy scores were similar in both countries; however, Israeli participants were slower and less efficient (p &lt; .05). The younger and middle-aged Israeli groups were more strategic and the older Israeli group followed fewer rules than the corresponding U.S. groups (p &lt; .05). Older participants in both countries were less accurate, efficient, and strategic than younger participants (p &lt; .05).

CONCLUSION. Limited strategy use and poor time allocation may contribute to difficulty managing cognitively demanding activities for older adults and may also be influenced by culture. Practitioners should consider these factors when screening people for occupational performance difficulties.

Effect of Play-based Therapy on Meta-cognitive and Behavioral Aspects of Executive Function: A Randomized, Controlled, Clinical Trial on the Students With Learning Disabilities

Introduction:

Although the effect of educational methods on executive function (EF) is well known, training this function by a playful method is debatable. The current study aimed at investigating if a play-based intervention is effective on metacognitive and behavioral skills of EF in students with specific learning disabilities.

Methods:

In the current randomized, clinical trial, 49 subjects within the age range of 7 to 11 years with specific learning disabilities were randomly assigned into the intervention (25 subjects; mean age 8.5±1.33 years) and control (24 subjects; mean age 8.7±1.03 years) groups. Subjects in the intervention group received EF group training based on playing activities; subjects in the control group received no intervention. The behavior rating inventory of executive function (BRIEF) was administered to evaluate the behavioral and cognitive aspects of EF. The duration of the intervention was 6 hours per week for 9 weeks. Multivariate analysis of covariance was used to compare mean changes (before and after) in the BRIEF scores between the groups.

Results:

The assumptions of multivariate analysis of covariance were examined. After controlling pre-test conditions, the intervention and control groups scored significantly differently on both the metacognition (P=0.002; effect size=0.20) and behavior regulation indices (P=0.01; effect size=0.12) of BRIEF.

Conclusion:

Play-based therapy is effective on the metacognitive and behavioral aspects of EF in students with specific learning disabilities. Professionals can use play-based therapy rather than educational approaches in clinical practice to enhance EF skills.

Executive dysfunction

PURPOSE OF REVIEW

Executive functions represent a constellation of cognitive abilities that drive goal-oriented behavior and are critical to the ability to adapt to an ever-changing world. This article provides a clinically oriented approach to classifying, localizing, diagnosing, and treating disorders of executive function, which are pervasive in clinical practice.

RECENT FINDINGS

Executive functions can be split into four distinct components: working memory, inhibition, set shifting, and fluency. These components may be differentially affected in individual patients and act together to guide higher-order cognitive constructs such as planning and organization. Specific bedside and neuropsychological tests can be applied to evaluate components of executive function. While dysexecutive syndromes were first described in patients with frontal lesions, intact executive functioning relies on distributed neural networks that include not only the prefrontal cortex, but also the parietal cortex, basal ganglia, thalamus, and cerebellum. Executive dysfunction arises from injury to any of these regions, their white matter connections, or neurotransmitter systems. Dysexecutive symptoms therefore occur in most neurodegenerative diseases and in many other neurologic, psychiatric, and systemic illnesses. Management approaches are patient specific and should focus on treatment of the underlying cause in parallel with maximizing patient function and safety via occupational therapy and rehabilitation.

SUMMARY

Executive dysfunction is extremely common in patients with neurologic disorders. Diagnosis and treatment hinge on familiarity with the clinical components and neuroanatomic correlates of these complex, high-order cognitive processes.