**4.2. Rating scales**

reduces the chances of the person who applies the test to observe executive dysfunctions that are more likely to appear in uncertain situations. Some uncommonly used tests due to difficulties in standardization include open-ended scenarios. A person can gather enough cognitive resources to perform executive functions tasks for a short period of time [64]. **3.** It is difficult to isolate the skills of a single executive function. Each aspect of the executive functions is intertwined, which makes it difficult to assess a single executive skill. For example, self-monitoring is part of impulse control or vice versa. These skills are different from each other, but it is difficult to distinguish them because they usually occur at the same time and affect each other. A low score on a test aiming to measure the performance

40 Occupational Therapy - Therapeutic and Creative Use of Activity

of an executive function may reflect the difficulty in a different execution process.

**4.** The executive functions may vary depending on the environment. Unfortunately, when evaluating executive functions, a child can perform differently in different environments. This can be clearly seen even when comparing home and school, different classes or everyday challenges. In such cases, it is important to examine the people, circumstances, and all sources of information that would lead to confusion regarding the child's functions.

For a child with executive dysfunction, some environments may have their own advantages (such as getting immediate, specific, explicit feedback from the teacher and learning in a highly structured classroom). The support and coherence of some people according to the nature of the child can intuitively increase this advantage. During interactive games, the success of the activity can be improved by providing clear, consistent, and clear results or awards for the child's actions. In such cases, it is important to include environmental factors in the developed treatment plan for the person and the activity success. It is important to gather information not only about the most challenging environment of the child's executive function but also in the environments that the child is successful at the same time. These exceptions may provide the data needed to describe the executive functioning difficulties and possible remediation strategies. It is important to assess the performance of

the child in different environments (home/school and daily/laboratory).

self-care in children.

**5.** Some factors can worsen (or heal) executive functions. These include self-care factors such as fatigue [65, 66], hunger [65], pain [67], stress [68], mood (positive or negative) [69], or lack of exercise [70]. Excessive stimulation with multiple sensory inputs (e.g. auditory, visual, and tactile) and multiple cognitive demands are also significant exacerbations [71, 72]. The sudden change of the surrounding and people around, a new teacher, new classroom, or new school may cause the difficulties in temporary executive functions occurrence. However, a child who is already struggling with compensation for executive function difficulties typically has less cognitive reserves [73]. The child is more vulnerable to the occurrence of any of these factors, and as soon as the effect of these factors accumulates, they become choked. For this reason, it is important to keep them under control. Teachers or their families can be informed of this by creating a checklist for various skills, such as

**6.** It is difficult to define appropriate peer comparison. It is important to identify the appropriate peer group when evaluating the executive functions. This allows you to make a In its simplest form, the assessment scale is a list of items that are evaluated to identify the presence, frequency, and/or severity of a behavior, emotion, or thought. A number of evaluation scales have been developed over the past decade to help to define executive functions. In general, such assessment scales are thought to be more predictive of executive dysfunctions than laboratory tests [82]. This difference can be attributed to the contextual factors (clinic/ home, school, community). This difficulty in assessing highlights the fact that it is important to understand the story of the assessed child.

When evaluating children, it is important to have age-based normative data. Smaller age groups allow the child's symptoms to be assessed more accurately in terms of appropriate development or consistent with a psychopathology. Many studies have shown a change in executive function performance during childhood and adolescence. Most of the statistical analyses for the assessment scales also show significant gender effects, against men in executive function ratings [83, 84].

Behavioral Rating Inventory of Executive Function, which is available for parents and teachers to complete developed to evaluate executive functions—for preschoolers (2–5 years old, BRIEF-P) and for school age children (aged 6–18 years). There is a self-report form for completion by youth 11– 18 years old (BRIEF-SR), as well as a group of forms for adults 18–90 years old (BRIEF-A). BRIEF was developed by a group of pediatric neuropsychologists who are collecting data on real-life executive function in the home and school environment. For this reason, expectations of daily adaptive needs and academic achievement provide reasonable information to parents and teachers. Normative data for BRIEF is somewhat restrictive because it is collected from a limited geographical area, and therefore may not represent the general population. EFBAI scores provide summaries of various aspects of executive functions (e.g. impulse, working memory, self-monitoring, etc.), and a clinician tells where and why a student struggles. It has been found that executive functions of BRIEF have a greater correlation with the descriptions of parents and teachers than the performance on laboratory tests and therefore considered to be a good standard tool for executive functions of the person.

**Acknowledgements**

**Conflict of interest**

No conflicts of interest.

**Author details**

Gokcen Akyurek

Ankara, Turkey

**References**

pp. 17-36

Author thank to Gonca Bumin Prof PhD for useful feedback.

Address all correspondence to: gkcnakyrk@gmail.com

UK: Cambridge University Press; 2010. pp. 3-16

control. Science. 2007;**318**(5855):1387-1388

ment. 2010;**81**(6):1641-1660

Psychological Association; 2007

Department of Occupational Therapy, Faculty of Health Science, Hacettepe University,

Executive Functions and Neurology in Children and Adolescents

http://dx.doi.org/10.5772/intechopen.78312

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Clearly, although executive functions are a tool for assessment. The Brown Attention Deficit Disorder Scales for Children and Adolescents (Brown ADD Scales) are based on the theory that attention deficit represents a developmental disorder of executive functioning. These assessment scales include organizing, prioritizing/activating, focusing/sustaining/recording attention, and executive functioning.

Conners 3 is another attention deficit and hyperactivity disorder (ADHD)-based assessment scale that includes executive functional aspects of the assessed areas. "Executive Functionality" includes the scale, initiation, time management, planning, prioritization, and organization concepts. Other scales in Conners 3 can also reflect executive functions such as attention/focus and self-control. The information obtained with Conners 3, such as the Brown ADD scale and BRIEF, can help identify the areas that require more focus and evaluation which leads to intervention initiatives [85].

Assessment scales such as the Behavior Assessment System for Children, Second Edition (BACS-2), the Conners Comprehensive Behavior Rating Scales (Conners CBRS), and the Achenbach System of Empirically Based Assessment (ASEBA) do not explicitly refer to executive functions, but they can provide information about executive functions. Comprehensive assessment scales such as these can help gathering relevant information in a broader context of issues beyond executive functions.
