Assessment of executive functioning in childhood epilepsy: The Tower of London and BRIEF

Abstract

Children and adolescents with epilepsy are known to demonstrate executive function dysfunction, including working memory deficits and planning deficits. Accordingly, assessing specific executive function skills is important when evaluating these individuals. The present investigation examined the utility of two measures of executive functions-the Tower of London and the Behavioral Rating Inventory of Executive Functioning (BRIEF)-in a pediatric epilepsy sample. Ninety clinically referred children and adolescents with seizures were included. Both the Tower of London and BRIEF identified executive dysfunction in these individuals, but only the Tower of London variables showed significant relations with epilepsy severity variables such as age of epilepsy onset, seizure frequency, number of antiepileptic medications, etc. Further, the Tower of London and BRIEF variables were uncorrelated. Results indicate that objective measures of executive function deficits are more closely related to epilepsy severity but may not predict observable deficits, as reported by parents. Comprehensive evaluation of such deficits, therefore, should include both objective measures as well as subjective ratings from caregivers.

Assessment of everyday executive functioning in children with frontal or temporal epilepsies

“…These studies found a high frequency of executive deficits reported by parents, reaching, for some authors, 45.2% of the clinical group [37] generally with global executive dysfunction [38][39][40][41][42]. Some results suggested that the WM and Plan/ Organize scales are the most frequently affected ones [41,43], but the Initiate and Monitor scales also seemed to be frequently impaired [41]. All these studies demonstrated that executive dysfunction is frequent in the everyday life of children with epilepsy and illustrated the value of BRIEF when used in assessing the EFs of these children.…”

“…Finally, only a few authors were interested in epilepsy risk factors. Some of them showed no correlation between the results on the BRIEF and the age at onset of epilepsy, number of AED(s), and seizure frequency [41], while others found a moderate correlation between the BRI and interictal epileptiform discharges [44].…”

“…In addition, several studies included nonhomogeneous patients or patients in whom the etiology of epilepsy was unclear [37,38,40,41,43], so it was impossible for these studies to assess the everyday EFs according to epilepsy type. Furthermore, some authors excluded patients with IQ b 70, rendering their clinical groups less representative of the population with epilepsy [40].…”

“…None of these studies used the teacher report of the BRIEF in the assessment of executive dysfunction, so they lacked the subjective ratings of children in the school environment [41], while other studies showed that parent and teacher reports are complementary (see, e.g., in ADHD [36]). In addition, several studies included nonhomogeneous patients or patients in whom the etiology of epilepsy was unclear [37,38,40,41,43], so it was impossible for these studies to assess the everyday EFs according to epilepsy type.…”

Behaviour planning and problem solving deficiencies in children with symptoms of attention deficit hyperactivity disorder from the Balobedu culture, Limpopo province, South Africa

“…The poorer performance of the two ADHD presentations was not unexpected. Several studies have reported that children with ADHD scored significantly lower on tests that measure frontal lobe functioning, especially planning, problem solving, mental flexibility and spatial working memory than their matched peers (Chiang, Huang, Shur-Fen Gau, & Shang, 2013;Culbertson & Zillmer, 1998;Hughes, 1998;Klorman et al, 1999;Larochette, Benn, & Harrison, 2009;Macallister et al, 2012;Nigg, Blaskey, Huang-Pollock, & Rappley, 2002;Solanto et al, 2007;Tripp et al, 2002). However, Houghton et al (1999) did not find that the ToL discriminated between children with and without ADHD.…”