Assessment and development of executive functions in school-age children

Liisa Klenberg

Research output: ThesisDoctoral ThesisCollection of Articles


Executive functions (EFs) are cognitive processes that direct, coordinate, and control other cognitive functions and behavior. They include processes of inhibition, attention, and self-directed execution of actions. EFs are involved in all purposeful activity, and for children, they are essential for learning and functioning in school environments. Difficulties in EFs are common in school-age children with developmental disabilities, such as attention deficit disorder (ADHD). Understanding normative development forms the necessary basis for the assessment of individual differences in EFs. The developmental findings, however, remain unclear due to methodological challenges in measuring EFs. In the clinical assessment of EF difficulties, EF measures that are sensitive to everyday difficulties are required.
This thesis consists of three studies addressing EFs in school-age children. The first study employed neuropsychological tests from the Developmental Neuropsychological Assessment NEPSY to examine age-related differences in EFs in a sample of 400 children. The second study investigated the methodological factors related to EF measures in a sample of 340 children using response inhibition tasks from the NEPSY-II, the second edition of the Developmental Neuropsychological Assessment. The third study aimed at constructing a new instrument, the Attention and Executive Function Rating Inventory ATTEX, for the clinical assessment of EFs and at verifying the psychometric properties of the rating scale in a sample of 916 children.
Age-related improvement in EF performance continued throughout the school-age period, decelerating at different times in the ten different tasks. The development seemed to proceed from inhibition to attention control, and further to fluency. A closer examination of age-related differences in response inhibition showed developmental variation even within this EF domain. The developmental change in response inhibition was apparent at school age, but the developmental proceeding seemed different when different outcome measures were used. Factors related to the cognitive requirements and the presented stimuli also had an effect on the results.
The ATTEX rating scale demonstrated high internal consistency reliability and good criterion and discriminant validity for ADHD. According to the ATTEX scales, the ADHD subtypes differed from each other in the EF profiles, and children with predominantly inattentive symptoms showed more wide-ranging difficulties in EFs than children with combined symptoms of inattention and hyperactivity-impulsivity.
For both the scientific research and clinical assessment of EFs, carefully examined, reliable, and valid measures are essential. In line with previous studies, this thesis demonstrates that when a large battery of EF tasks is used, the developmental proceeding varies across the different EF components. The relative differences between EF domains, however, may actually reflect the characteristics of the measures more than the EF constructs as such. Numerous factors related to the measures, such as the task materials and stimuli, the outcome measures, the involvement of other cognitive processes, and task sensitivity to age-related difference, have critical effects on the developmental results. For the clinical assessment of EF difficulties, the newly constructed EF rating scale proved to be a suitable measure both for screening and examining the detailed EF profiles of children in school situations.

Original languageEnglish
  • Hokkanen, Laura , Supervisor
  • Korkman, Marit, Supervisor
Place of PublicationHelsinki
Print ISBNs978-951-51-0866-1
Electronic ISBNs978-951-51-0867-8
Publication statusPublished - 2015
MoE publication typeG5 Doctoral dissertation (article)

Fields of Science

  • 515 Psychology

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