#53 Navigating Executive Function Tests and Screeners

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Episode 53 of the Executive Function Brain Trainer Podcast

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Erica: Welcome to the personal brain trainer podcast. I'm Dr. Erica Warren.

Darius: And I'm Darius Namdaran and we're your hosts. Join us on an adventure to translate the scientific jargon and brain research into simple metaphors and explanations for everyday life. We explore executive function and learning strategies that help turbocharge the mind.

Erica: Come, learn to steer around the invisible barriers so that you can achieve your goals. This podcast is ideal for parents, educators, and learners of all ages. This podcast is brought to you by Goodsensorylearning.com, where you can find educational and occupational therapy lessons and remedial materials that bring delight to learning. Finally, you can find Dr. Warren's many courses at, Learningspecialistcourses.com. Come check out our newest course on developing executive functions and study strategies.

Darius: This podcast is sponsored by Dyslexiaproductivitycoaching.com. We give you a simple productivity system for your Apple devices that harnesses the creativity that comes with your Dyslexia. All right, Erica, nice to see you again. What are we going to do today?

Erica: This is going to be a cool one. We are going to be navigating executive functioning tests and screeners.

Darius: Okay. Now, why is this important?

Erica: Well, a lot of people want to know whether they have significant executive functioning deficits. And people want to know whether they really are deficient in those skills. And if they are able to discover that, then they can figure out what the next step is, which is often getting a coach or perhaps doing some cognitive remedial tools. We've talked about a lot of those things in the past, but I think a lot of people really wonder about, hey, is this something that I should address? And how do I do that? Because as we know, executive functioning is really quite complex, and there are many aspects of executive functioning. And I think that there are those tools that look very specifically at working memory, inhibitory control, or cognitive flexibility, or even higher-level executive functions. But if people are curious about, how do I assess those issues to see if that's something that I need to be aware of, or perhaps maybe I want to get services for my son or daughter, it's kind of a cool thing. Or even the elderly.

Darius: So how does it work? Executive function tests and screeners.

Erica: So I guess basically what we're going to be looking at is how do you assess this skill? And there are a number of ways that you can do that. I guess we're going to talk about, let's see, six different ways that you can assess executive functioning skills. The first one is through clinical interviews. So that's pretty easy. That might just be something as simple as you speaking to. I guess it could be a lot of different people. It could be an educational therapist, could be an executive functioning coach. It could be someone that does neuropsych testing. But a clinical interview is really just an opportunity to really assess somebody verbally about or even though writing their daily functioning abilities, their struggles, where you're gathering a lot of information, perhaps from teachers, parents, significant others, and the individual themselves. You might have executive functioning issues after a head injury. And clinical interviews can be very helpful in learning more about what the injury was about and what the symptomology was like. So that's one. So clinical interviews are number one.

Darius: Could you go through all six quickly as headings and then go through them a little bit more depth just so we've got the big picture?

Erica: Yes, let's do that. So we've got number one is clinical interviews. Number two, observations. Number three, functional neuroimaging. Number four, performance based real world tasks. Number five are screeners and rating scales. And then number six are standardized neuropsychological testing.

Darius: Great.

Erica: So we've talked about the clinical interviews, and did you have any questions about that?

Darius: No, pretty straightforward. I thought it was quite interesting. You mentioned about different stages in life or incidences affecting your executive function. I think that's something that's happened throughout our discussions that we've talked about how COVID has affected people's executive functions. And you've got this brain fog that comes from the huge amount of fatigue involved. And also does it actually affect your mind, long COVID? I've got a client that I help, a, consultant, medical consultant, and she specializes in COVID, and I help her with her Dyslexia and executive function skills, with Dyslexia and workplace strategy coaching and so on. She's like, we need to be doing this for long COVID sufferers because they exhibit all of these kinds of similar traits and it's because it's affecting their executive function. So there's all sorts of things that can affect your executive function. And I think long COVID is a big one. Did we not do an interview on that, a discussion on that a while back?

Erica: I think we did. I don't know if we focused it entirely on that, but I know that we've talked about it.

Darius: Yeah, because it's a big deal. There's a lot of people with long COVID and it is affecting their basically they call it their cognitive function, but essentially what they're saying is it's actually affecting their executive function.

Erica: Yeah, there are quite a lot of conditions that do that. There are pandas and even just even having the flu. There are various ones that, oh, a big one is Lyme disease. Lyme disease, I had that, and that had a profound impact on my executive functioning skills. So there are quite a lot of different ailments that we can have that affect executive functioning. So, yeah, perhaps you just had Lyme's disease or COVID and you're feeling that your processing isn't just up to what it was. Then you can use some of these assessment tools to determine if it's significant and whether there's anything that and of course, you and I talk a lot about the types of things that you can do with executive functioning problems. And I know, coming up soon. We'll also be talking about gamification and activities that you can do to strengthen those skills. So that will be coming in the near future as well.

Darius: Okay, so, number, two observations. How can we learn about executive functions through observations?

Erica: I've done that myself, where I've gone into schools, and I've done school observations. So this could be an observation of a professional observing a student in a school setting. It could be someone being observed in an elderly folk’s home to see how their executive functioning skills are. It could be a home evaluation where someone comes in to observe how somebody is managing in their home. But it provides all sorts of just insight about what's going on in their everyday world that can give some really valuable information. So, really, the first two are qualitative assessments. So if we were to categorize them so some of these are qualitative, and some of these are more quantitative.

Darius: And I think the quantitative ones are often much easier in the younger age groups in many ways, I think. Would you say that well, the reason I'm asking that is I'm noticing when I do executive function coaching, workplace strategy coaching fundamentally is executive function coaching. One of the things that I've been doing quite a lot is asking them to do a particular exercise at work and go through the workflow that they would normally be going through. And often it's people with Dyslexia. So it's affecting the processing issue. But it's not always just processing. It is executive function as well. And so just observing how you work through a workflow and stepping back and observing yourself and having someone there to observe it as well. And they say, yeah, I always have difficulty with this stage of the project, copying and pasting it from here to there. I get distracted or whatever, or overwhelmed, and I don't know why. And you're like, well, that's a working memory issue. Why don't you split screen it? And we've talked about this, and they go, oh, gosh, yes, that might work. And, often it's also self-observation as well. And it's helpful with someone else.

Erica: Yeah, self-observation is I hadn't thought about it that way, but absolutely. Observing your own actions. And something that I found to be incredibly helpful is seeing videotapes of yourself.

Darius: Ouch. yes. That's hard, isn't it?

Erica: We don't have this objective view, and we can't always see how we're behaving. We don't always witness our facial expressions or nonverbal cues that other people know so well. So I found that some of the richest lessons for myself is watching myself in videos, because you start to observe these mannerisms that you weren't even aware of.

Darius: So we talked about the qualitative. I'm finding it hard to say that. Qualitative, qualitative, qualitative aspect of executive function tests and screeners. What about the qualitative ones? The quantitative ones, quantitative ones?

Erica: Well, let's see. I'm looking forward I guess all the rest could be considered quantitative.

Darius: Yeah. Tell us about functional neuroimaging.

Erica: Functional neuroimaging is really interesting.

Darius: Can you really get this done for yourself, or is this just in science?

Erica: experiments, I think they typically are done in research-based experiments. However, I think that they're going to become more and more available to the public. But basically, it's the technique of using MRIs and Pet scans, and they provide images of the brain activity during tasks. And there are certain parts of the brain that are activated during executive functions, and they're able to give you a task and then observe whether those parts of the brain technically light up and are being utilized, and if they're not. So I think it's also typically something that would be used with a head injury to determine if somebody had significant impact. For example, if they had been in a head on collision and they really hit the front of their brain, that would definitely impact executive functions. And neuroimaging could determine a lot, but yeah, I'm curious to see how that in the future could be, a really amazing tool.

Darius: Yeah. Well, let's get back to reality, though. What can we use as ordinary people to test executive function?

Erica: There's also performance based real world tasks, and these are tasks designed to mimic daily life. Like things like planning a trip, managing finances, cooking a new recipe. I could see how you could throw that in with observations, so you could quantify it, or you could look at it qualitatively and take notes on it if you are observing it. So I could see it could go either way.

Darius: And are there particular tests where you can because we're talking about tests and screeners here. Do you get performance based real world tests of executive function?

Erica: I think that that could be something that could be designed. I imagine that there may be certain ones out there that look, I don't know of any in particular. I think, like, a coach, for example, could come up with a series of tasks, or even interview based on a series of tasks, like, how are you doing with or perhaps the person that they're working with has a trip coming up, and they really struggle with planning a trip, and then you could do it together.

Darius: I hadn't thought of it in this way of wording performance based real world tests, because that is qualitative and also quantitative. It bridges the two realms. And I'm doing that with when I meet my clients, I'm saying the three main things I keep asking are, how are you taking notes? How are you making maps, and how are you setting goals? Because each one of these three actions real world tasks of taking notes, making maps, and setting goals. Maps up to an executive function skill. So taking notes, maps up to working memory, making maps, maps up to cognitive flexibility, and setting goals. Maps up to inhibitory control, cutting things out and saying, no, I'm going to focus in on this. And so it's fascinating when you do stop and just sit back and say, here's a real-world task. Like, I'm just about to go on a trip. How are you going to use Apple Notes to do that real world trip? And it seems absurdly simple. I've got people who are very accomplished executives, okay? And they say to me, Darius, I'm really embarrassed because you're just going to laugh at me right now. And, when I do this, you're going to just laugh at me. And I'm going, no, I'm not going to laugh at you because I know what it feels like. And so they open up their Apple Notes, they go through it, and they go, when I'm doing a trip, I do this. And they're trying to do it in Apple Notes, but they're finding it really hard. Not because they don't know Apple Notes, but it's like an executive function thing, but just intentionally sort of slowing things down. And observing makes you see where your strengths and where your weaknesses are, but with the confidence that there is a tool or a technique to help you go onto the next stage. Because one of the things that I'm seeing with people is that they're thinking to themselves, well, what's the point? Because nothing's going to change. That's just the way things are. And we know that isn't just the way things are. that's the way things are with your current skill set. But once you get a different skill set that fits your mind, it's different. And I would really encourage people with all of this. If you're listening, think of this like getting a new pair of shoes that fits or getting a pair of running shoes that help you run instead of you've got shoes that fit, but they're dress shoes and then you go running in them. Of course you can run in them. Absolutely. But can you run 5 miles in them comfortably? Probably not such a good idea. You get tools that fit your shoes, and likewise, I'm a great believer in getting tools that fit your mind.

Erica: Right, absolutely. So I think you've used performance based real world tasks quite a bit when you work with individuals, and that is such a great way to assess. And what I like about it is that it is real world. And when I typically work with students, I'm thinking about planning, time management and organization, which is looking at more of the higher level, but it unites all of these individual skills because real world tasks are what it's all about.

Darius: Yes.

Erica: Right. That, we don't really utilize this one cognitive area by itself. We unite them all in order to do these more complex tasks. And so the performance-based assessments I really like. And you can individualize them because someone will say, hey, this is really hard for me. And then you can really pull it apart and figure out, oh, let's see what aspects of executive functioning are tripping them up. And you can build that skill, but I found that you have to know a fair amount about executive functioning in order to be able to do that. So once you have a really good understanding, then the performance based real world task assessment comes quite easily.

Darius: Yes. So screeners and rating scales tell us a little bit about how screeners and rating scales fit into this landscape.

Erica: Sure. I think there are those people that just want something that will give them just a quick indicator, is this an issue for me? Because they may not have that perspective that other people have, or perhaps they really want to dig deep and they want to say, okay, I get the sense that there's something going on. Is it significant? And if it is, what is it? Is it working memory? Is it inhibitory control? Is it cognitive flexibility?

Darius: What kind of screeners are out there? Is there like, official kind of this is the executive function screener that researchers have come up with, or is there a whole range of them? What determines how do you create an executive function screener? What's behind it?

Erica: So there are screeners and there are rating scales, and they're kind of the same thing. So I actually created one called the executive functioning competency screener. I was trying to make something very affordable, which some of these aren't. I'll start off by mentioning all of them. We've got my executive functioning competency screener. We've got the Behavior Rating Inventory of Executive Functioning, or the BRIEF. We've got the Delis-Kaplan Executive Function System, and then we've got the Adult ADHD Self-Report Scale. Ah, so those are the four that I've been able to uncover. The reason why I created a screener was because I wanted something that was quick and efficient and that could help people discover if they had significant issues with executive functioning. One of my frustrations in the years of utilizing and looking at what's out there is that I found that there were just little pieces all over the place. Some of these other rating scales are decent, but you usually have to have I can administer them, but most other people can't. You have to have significant training in testing, or a psych degree, at least a master's or doctorate, again with some testing background. So some of these require that, or they're expensive. Perhaps the inventory themselves isn't expensive, but you have to buy the whole kit, which is really expensive, and so it's a bigger deal. And many of these take quite a bit of time to administer as well. So a lot of people just don't want to get into, oh, my gosh, so then I'm going to have to have a full neuropsych battery. And then you're looking at thousands of dollars because then you're also hiring somebody to administer them and then interpret them, and it can get expensive.

Darius: All right, well, why don't we keep yours to the end? Okay. And can we go through the other three? This isn't like a sale, podcast for yours, per se, because there's strengths and weaknesses to each one. It's just good to know the landscape. So the Behavior Rating Inventory of Executive Function. What is that? I suppose let's create some categories here. So you've mentioned a few things. First of all is time. How long does it take to do, and where does it fit on the self-administering scale administered by you or someone else, and then cost. And I think what might also be useful is effectiveness in terms of what information it gives you about what you need. Could you rate it on that?

Erica: I mean, I don't know them in great depth. I haven't given all of them myself, just because there's a lot to purchase, there's a lot to learn. I never fully went into I did neuropsych testing for many years when I was in graduate school but didn't go into that field. I'm much more in the camp of taking the tests that have already been administering, that have already been administered, and then providing the services. so basically, what these other three are typically done by a neuropsychologist.

Darius: Okay?

Erica: And they're used for children, adolescents. Some of them also have adult versions as well. And they are all behavior ratings. So you're rating them on specific behaviors associated with executive functions. So typically, that's the Brief and the DCFS, which is the Delis Kaplan Executive Functioning System. The Delis Kaplan also looks at a series of tests to evaluate higher level cognitive functions as well, which is really the higher-level executive functions, which is getting more into the planning, time management, organization, reasoning. But the Brief does that as well. And then the Adult ADHD Self Report Scale is looking probably more specifically at inhibitory control, and it helps with assessing the symptoms of ADHD, which often involves the executive functioning deficits. The reason why I created the Executive Functioning Competency screener. There were a few reasons. I wanted to find something that was or wanted to create something that was very affordable, that you didn't have to have all these degrees in order to administer it. I wanted to also make it an online digital screener as well, so that it's something that you could just take on your computer. I wanted it to create a comprehensive report that defined very specifically what your executive functioning problems are. So it looks at do you have working memory issues? Do you have inhibitory control? Is it cognitive flexibility? It also looks at higher level executive functions. And then it has, this kind of comprehensive report that goes into what are your areas of executive functioning weaknesses? And then it has an online user dashboard, for example, or a school, or you're a teacher, and you want to be able to compare your students. You're able to see how many of your students have working memory issues, how many have inhibitory control issues, how many have cognitive flexibility issues. And then there's a whole training section that helps individuals figure out how to meet the needs of those learners. So how do you teach those skills? How do you accommodate those that have deficits in those areas? So that I offer its more continuing education. So if you didn't know anything about it, you'd still get a lot of information, and you really could do a lot of things. And then I make recommendations to different cognitive based tools that you can use to strengthen those skills in need. So my frustration, and it goes way back to when I was doing or conducting neuropsychological testing in graduate school, was that there were those that were doing the testing, there were those that did the services. The people that were doing the testing knew nothing about services, and the people that were in service knew nothing about the testing. And the real wealth is when you understand both, because then you can figure out what's going on and you know how to accommodate it and how to strengthen the skill. And so I really wanted to create an assessment that bridged that gap.

Darius: Brilliant.

Erica: So that not only do you figure out if you have these issues, but you also can figure out how to address them.

Darius: Yeah, because it's one thing as a teacher or a parent to be given a list of recommendations, because you've seen this on reports, Dyslexia reports, ADHD reports. These are what I would recommend. But you don't often see why I would recommend this particular action be taken because of working memory issues or because of inhibitory control, or because of such and such. Often that because really empowers you, because you become self-aware, rather than, oh, I have to do this because someone told me to.

Erica: Right, well, and the why is also answered in the training section, because what I do is I think it's about a 45-minute video where I go into depth of what is working memory, and then I teach them about the different parts of working memory. We look at the inner voice, we look at inner visuals, spatialization skills, so they really understand the why. Why do I have to do this activity to strengthen working memory? Why do I have to do these activities to strengthen control? So I, really wanted to keep people informed so that they understood the whys and the hows.

Darius: So can people go and use this just now?

Erica: they can. It's available on mymemorymentor.com and I have a series of assessments that I've created in the same pattern of being able to give you a screener that then gives you a report and training materials and recommendations. So I have them available for executive functioning for Dyslexia. I have a Dyslexia screener. I also have one that helps you to understand how each individual processes. And then I'm in the process right now of creating one called the Parts, which should be out at the beginning of next year, which is the Phonological Assessment for Reading and Targeted Support. That's it. I have to think about the acronym. It still isn't automatic yet because I'm in the midst of creating it. But yeah, that's my whole plan, is I really want to create a series of these affordable screening tools because the testing is just slow, expensive, and it, doesn't necessarily give you the why and the how. So if we can do that, great. Anyway, but let's go on because there's one more category, and this is the standardized neuropsychological testing, or psychoeducational testing. People have many different names, and typically this is something that students will have done if they have learning, pretty severe learning difficulties. They can do the testing through the school, which isn't always great because there's a conflict of interest in the United States. So the testing doesn't tend to be good enough from my standpoint. But you can also go outside and have testing done. But wow, it's really expensive. We're talking many thousands of dollars. And then you've got this really comprehensive, really complicated report that's hard to make sense of. But I also, after doing it for many years, find that there's a wealth of information in doing this type of testing. It really helps you to understand your brain better if you can get someone that does the testing that can really write a report in a way that helps you to understand it, so that they write it more in a layman's terms is great, and it can help you to understand how you process and how to optimize. My dissertation was on, college students that were diagnosed with learning disabilities for the first time in college. And I wanted to see how it impacted their sense of self. And it was profound because they thought they were stupid, or they thought they were alone. And once they were able to identify with a diagnosis, they felt vindicated and validated. So there's a lot of wealth. And of course, if you're in school or you're going back to school and you need accommodations, you can get mandated accommodations in the United States if you have a diagnosis. So sometimes that can be very helpful. And with a diagnosis, you can also get workplace accommodations, which you know well about, which I'll have you talk to, I'm sure, during this little section. So there are very specific neuropsychological tests that measure parts of executive functioning, and we'll talk about some of those, but I know you probably have some thoughts.

Darius: Well, I know over here in the UK, the British governments got, a very underused grant called Access to Work for people with ADHD and Dyslexia and any other kind of well, they categorize them as disabilities. It's really hard to think of dyslexia and ADHD as a disability, but they've been categorized as disabilities because often the environment around you disables you from accessing certain information if you think and process a certain way. So it's often the system around you that's unable, to do something. And so the British government puts in a grant called Access to Work, which will allow you to access workplace strategy coaching software, training for different kinds of software, and also hardware. They'll buy headphones, laptops, iPads, all sorts of things that will be useful to you to help with any difficulties like that. And the surprising thing in the UK is you don't need, a neuropsych test, you don't need a formal report. So what they've decided is that if you self-report dyslexia or you self-report ADHD, you will get everything that a person with an official report gets.

Erica: That's amazing.

Darius: Yeah.

Erica: And isn't this something that you can help them with?

Darius: Yes, it's something that I do with clients. A lot of my clients are Access to Work clients, and they get given a grant of 15 hours of executive function training. The government pays like 15,000 pounds for it and gives you a grant for that. And you can choose who you can get to give you that training. And I, can be one of them. Or there's other companies out there that can give you that executive function training. They call it workplace strategy Coaching.

Erica: could you help somebody if they were like, oh my goodness, I want help with getting that grant and stuff like that, would you help them get the grant too?

Darius: Well, I used to, but I have to be honest, I am so busy right now that I don't so much now. But if you did get in touch with me and wants to, get some help with the grant yes, I would. It takes about 15 minutes to half an hour to do the grant, but you really have to do it. If you're in the UK and you've got Dyslexia or ADHD, I, highly recommend you phone up Access to Work and just say, hey, look, I've got ADHD. Can you guys help? And they go, yes, we'll get someone to give you a call. And they go, give you an assessment, it's free, it doesn't cost you anything. They do it over the phone and, they talk to you for half an hour. They say, what have you got difficulties with? And you go, well, I find I get distracted by lights sometimes. And they analyze a little bit about the way you are. So, for example, they'll say, tell me a bit about your workspace. Is your back to your colleagues? Are you facing it? Is it open plan? And so sometimes they'll say, well, maybe you need to get a screen or something to put it down here. Or a second monitor and we'll pay for that. And they just create a shopping list of right, you need a second screen, you need a cable to connect it to. You need this bit of mind mapping software; you need this speech to text. You need some sound canceling headphones. And they just make a list. Bang, bang, bang, bang. Right, go buy it. Go get these trainers to come out and train you on how to use it. And people do it and it transforms people's work lives because it's really hard to explain to someone the impact of this on your life if you've not experienced it.

Erica: Now, do the people have to buy it themselves and then they're reimbursed? Or are they given a credit card? How does that work?

Darius: Yeah, well, the way it works is, it depends on how big your company is. Okay? So the way it fundamentally works is that you go out and you buy it and then the government repays you a month later. So it's like you put in your receipts and you send in your receipts and then they send the money to your bank account. So it's like claiming expenses from your employer. You claim the expense, but you don't go away and do it straight away. So what happens is, in simple terms, you call them up and then about a month later, they call you and they say, right, okay, we're ready to do your application. Do you have a few dates where someone can speak to you for half an hour, an hour and make a few dates? A couple of weeks later, the guy phones you up or lady, they talk you through what your needs are. A week later they send you in a letter saying, this is the grant you've been given of, normally somewhere between one and a half and, 4000 pounds. Somewhere between that, this is your grant. And then you know that because it's on your grant, you're going to be paid that money back. Then you go and buy the hardware and claim it back off the government. And you go and get the training, pay the trainer, and get claimed back off the government. They do have a thing for small self-employed people where if you're a smaller company, smaller than 250 people, the trainer like me can invoice the government directly and get paid directly and you don't have to spend any money on it because it's directly invoiced.

Erica: I have a great idea. Why don't we do a whole episode on this?

Darius: All right? Yeah. Okay.

Erica: Because that's the other thing is if then someone says, how do I do this? You can say, hey, listen to our podcast episode.

Darius: Yeah, let's do that. That would be good. Yeah, because I haven't done a full, I've done it a little bit on the Dyslexia Explored podcast two years ago. But I've learned so much about the process that is just kind of opaque. It's not written down. there's no manual. I've spent a lot of time figuring out the system.

Erica: Well, if you think about it, having a podcast episode on this could be wonderful because they can just listen to it and follow the steps.

Darius: That's right.

Erica: Yeah. And that way then we'll get back to what we were talking about today. But I think this is such a valuable conversation and someone may not even know that it's hidden within this episode. So we'll focus a whole episode on this. We'll do that really soon.

Darius: You know what's interesting, Erica, though? that ties into the whole testing side of things. We've got to the point of standardized neuropsychological testing, formal tests. We covered all six now. So you've got all the way from the informal self-observation or someone else observing you now a little bit more former, looking at your workflow with someone and just observing much more intentionally. And then you've got the screener side of things, where you filled in that gap of the screener, and then you've got the rating scales, which are administered by someone a bit more, like you said, a psychologist, and it's more expensive. And then you've got the full neuropsych testing that is super expensive, and you filled that gap in the middle. The interesting thing, when I was talking to Dr. Brock and Fernette Eide about Dyslexia and their book The Dyslexic Advantage, and they were saying when I was speaking to them about that, they've got a screener. And, their observation was, there are number of people in America getting workplace assistance just from screeners.

Erica: That's what I was thinking too, because and people could probably use all of my screeners for that same purpose.

Darius: Exactly. That's what I'm thinking.

Erica: It comes with a comprehensive report, so they could just forward that to whoever needed.

Darius: Yes, absolutely. And I think it's really important within this whole realm that people feel empowered to do something about it. You don't have to wait until someone on high has officially told you and anointed you as you. Thou hast ADHD or thou hast executive function difficulties or you have Dyslexia. You can self-report these things. It is allowed. And, because you are often the person that can experience it the most and see it the most, you're not just having a snapshot once you hear about these things. It is allowed to self-report and self-solve some of these challenges because that's what it's all about, not creating some sort of excuse or whatever. sometimes people fear that, oh, is this going to create a sort of an excuse culture or what? No, it's actually creating an explain culture and you explain it and then you solve it. And that my heart in this, that you don't explain it and then excuse it away. You explain it and then you solve it. Because often people who have difficulties with executive function, ADHD, or Dyslexia, they have been working super hard against a tidal current against them that actually they're really hard workers, although it might not look it on the face of it, because you're not making so much headway, but it's like being caught in a riptide. This is a good analogy. We love our analogies here. You know what it's like when you get caught. Have you ever been caught in a riptide?

Erica: yes. It's intense. It pulls you from underneath.

Darius: Yeah, when you're in a riptide. For those of you who've never been in a riptide, it's super dangerous and super important to understand. You're on a beach. You're swimming along quite comfortably. You're maybe out in the water, swimming out a little bit. You turn around, you start swimming back. You're working at it. You're swimming hard. You're making some good ground. You're making speed. Your speed through the water is good, but then all of a sudden, you start noticing the land's not getting that much closer. And what do you do? You start increasing your speed of swimming, and the land's not getting any closer. You're staying in the same place. And that's the danger zone, because then you get exhausted, and the moment you use all of your energy going in the same direction, you get worn out and you get sucked out to sea, and often you die. So what's the answer is, instead of sailing directly to where you think you should be, which is home on the beach, you swim 90 degrees to the side, which makes complete no, makes no sense whatsoever to swim sideways. But what happens is, when you swim sideways, you get out of that current that's pushing you out, because it's not across the whole beach. It's one little channel that's pulling you along. That way you go sideways, and then you start swimming backwards. You start seeing the ground coming towards you. Go, I'm, out the rip current. And it's the same analogy with Dyslexia or ADHD or executive function. You're swimming and thinking, I'm trying my best, but I don't seem to be getting there. Sometimes you just need someone or something to come along and say, hold on a minute. Are you in a rip current right now? And you're like, oh, gosh, I could be right. Swim sideways along, do this technique like a test, a screener, something like that. And you go, my God, I am in a rip current. I need to go sideways. You get out of it, and you swim back, right?

Erica: It's all about learning these little strategies. And that's the thing, is, so many individuals that have lived with these difficulties their whole lives become what they call learned helplessness. They have this sense of learned helplessness where they've tried, they've tried, they've tried, they've tried, and now they've kind of given up.

Darius: Yes.

Erica: And sometimes it's just simple little tips tools tricks, tech support. Different tech tools that can really completely change your life and right, get you back into the groove so that you're able to show your true ability and true capacity and you can build your self-esteem again and all of that. But ah yeah, that's a really good analogy. I like the analogy of the riptide that really by doing these types of assessments, you can figure out that you're in that riptide. And now that you know you're in that riptide, there are people out there that are happy to help you and show you a way back to the shore, back to success, back to confidence and all of that. So that's a really good one.

Darius: I mean, I know I've got a dyslexia screener on the apple store called the dyslexia quiz, and it's the number one dyslexia screener on the apple store, and thousands of people use it, and that's helped people a great deal, just kind of wake up. Because often when you do these screeners, what happens is you kind of go through the screener and you think, right, take Dyslexia, for example. You're like, all right, dyslexia is about reading. Do you have some difficulty reading? Yes. Do you have difficulty with writing these kinds of letters? And you go, Hold on a minute. Yes. Do you have difficulty giving presentations? Yeah. What do you mean? And then, do you have difficulty remembering the timetables? Do you have difficulty remembering the time? And they go, Hold on a minute. And there's, like, 50 questions. And they're going, yes. And they're like, oh, my goodness. Ah. Are these all traits of Dyslexia? And you're like, yes. And they're like, oh, my goodness. And those are all, like, 50 little micro rip currents. riptides. And I think that's kind of the element here, also, is that when you're in a current, it's not always the same thing. And that's part of you get to know the beach, as it were, of your life, a regular beach. As a surfer, you're like, right, the rift currents are there and there, and I'm okay here. Maybe the storm comes along and changes the internal landscape of the beach, and then it changes a little bit, but you start getting too aware of where those danger zones are for you, whether it's in working memory. And I think it's really important because sometimes you think, oh, I can never remember anything. Well, maybe if you did something with your working memory side of things, you could.

Erica: Yeah, there are so many cool tips and tricks and tools that you and I know that even I mean, I definitely felt for most of my life that I had a really bad memory, but once I learned memory strategies, then it changed everything. Yeah. So there's a lot of hope out there.

Darius: And on, all the three, I think people might say, with working memory, they may go, oh, I've got a terrible memory. And you think, well, maybe it's not your memory. Maybe it's your working memory, maybe your memory is actually quite good. But the working memory, that gateway into your memory, is getting blocked out by certain things, and you become self-aware of them. And you clear those blockages by taking notes or using memory strategies to get it out. Your working memory straight into your long-term memory to keep your working memory clear. Or it could be inhibitory control. I can't stay focused. Well, maybe you can stay focused if you find some strategies for it. Or I can't be adaptable. Well, maybe you can if you learn a bit about cognitive flexibility, et cetera. So it's identifying where those root currents are. And I think tools like this or other tools, any one of these, are helpful at different points often in your journey.

Erica: Absolutely. And we'll just go into the last one, which is the standardized neuropsychological testing, which I find tends to be evaluating parts of executive functioning, which can be very useful. So if it's already been determined that you have maybe working memory issues and you want to go a little bit deeper well, sometimes they're not deeper. Let's look at some of them. There's the Wisconsin Card Sort, which evaluates abstract reasoning and the ability to shift cognitive strategies in response to changing environmental contingencies. And that really has to do with cognitive flexibility. So that's what that's looking at primarily in executive functioning. We also have the Stroop Color and Word test, which assesses the ability to inhibit an over learned response in favor to a less familiar one. So now we're looking more at inhibitory control. And it's interesting, a lot of the cognitive remedial tools that I created to address strengthening these skills, I went back to some of these same things of, okay, the Stroop test is based on research and that it is measuring inhibitory control and also measures some working memory as well. So a lot of the cognitive remedial tools that I create are based on the same stuff that they used for testing. There is the Trail Making test, which is a measure of visual attention and task switching. So visual attention has to do with working memory as well, because you're pulling in that attention into your working memory. But the task switching piece of it is cognitive flexibility again, and then we have Tower of London or Tower of Hanoi, which evaluates planning and problem-solving abilities, which looks more at the higher-level executive functioning. We've got the Continuous Performance Test or the CPT, and that assesses sustained attention and impulsivity, which, again, is more in the inhibitory control area. We've got the Ray Ostrich Complex Figure Test, which evaluates organizational and planning abilities, again, into the higher-level executive functions. We've got the verbal fluency test. As you can see, they're quite a lot. And in verbal fluency tests, they do things like participants list as many words as possible, starting with a given letter or maybe they have to come up with how many animals can you name in 60 seconds? And it's really about being able to access that information within your working memory from long term memory and how fast can you do it and how quickly can you process. And then also having that expressive language component. And there are two more. There's the clock drawing test, which I think is really interesting. I didn't know about this until relatively recently when I was doing research for this podcast. And this is where participants draw a clock and set the hands to a specific time. And this tests spatial orientation, planning, and abstract thinking. And when I was exploring this, I was looking at the different types of answers that people give and it's really interesting how some people have a hard time putting the handles in the middle or sometimes and they have trouble with the shape. But it has to do with kind of that spatial orientation which I thought was really interesting. And then finally, which is a very popular scale of working memory is the digit forward and backward subtests of the waste or Whisk. And I always get a little frustrated with this because I often see in neuropsych reports that they will make these generalizations that if somebody does poorly on that, that their whole working memory is not very good. But really what we're looking at is just a piece of working memory because working memory is not just the auditory piece, but there's visual pieces. But it is a pretty darn good indicator that there is an issue there. But it doesn't assess all aspects of working memory.

Darius: That's a lot. Now, in a standardized neuropsych test, do they do all of these?

Erica: They kind of pick and choose and sometimes they might just choose to do the brief instead, which is more not really a quantitative measure where you're doing an activity and they're seeing how many are getting right. Brief is more of, again, a rating scale. So these neuropsychological tests aren't rating scales. They are can you complete this task? And then it's an analysis of how you complete the task, whether you can access information from memory, whether you can draw something out and then they analyze your drawing or your response. So it's just another type of assessment.

Darius: Is it not just better to do the more objective activity-based ones rather than the observational ones? Because isn't the observational one more prone to being I'm, just thinking. And the reason I'm asking is because I know people will be thinking this, is that some people create strategies, internal strategies as they get older to complete certain behaviors and so on. And it looks like they've not got a problem, but they've created a strong coping strategy. But they do have an underlying challenge and their solution is working, but it's only partially working enough to fool you into thinking they're sorted on that. But when it hits. Because I see this with 30-year-olds and 40-year-olds. Their strategies that worked for them when they were working on their own as an individual contributor completely get shattered when they become a manager or a leader of people or a team. And all of these strategies have been working for them individually. But when it comes to dealing with a team, they break down because they're not strong enough, because they're not actually addressing the underlying issue. And I see this at the 35- to 40-year-old mark where someone gets better at what they're doing. They're really good at their job, but they get promoted into a realm where they have to manage people. And that creates a whole new set of executive function skills, right. That they're not actually got the right skills, the right shoes for that run, as it were. They're going to go start running. They've been doing lots of rowing practice. They didn't matter about their shoes. And now they're going to start doing, I don't know, a triathlon where they do some rowing and some swimming and then some running, and they'll be absolutely fine. it's not a very good analogy, but it just becomes a different activity, but still involves fitness. What are your thoughts on that?

Erica: It takes me to performance based real world tasks. So I think there are different assessment tools for different situations. So I would say in that particular, situation, I would move more towards the performance based real world tasks and have clinical interviews where you can discuss with them what's going on, what has worked for them, what hasn't worked for them. And then you can really assess it most clearly, I think, that way. Or a screener again, what the screeners or rating scales are doing is you're just rating whether this is an issue which helps to know you have to have a certain amount of self-perception with those. Now if you are a second grader, then that's going to be a little bit harder. Now their parents might be able to take it, take the screeners or rating scales and oftentimes they triangulate where they'll have maybe a professional, a, ah, teacher and the student take it and then they can get some really good information. But there are those times where doing the neuropsych testing which really breaks it down to a very specific cognitive area that they're assessing in a unique way so that there's not any practice effect that can be very helpful.

Darius: Yes.

Erica: So I think what it comes down to is it depends on the person, it depends on their situation. If they've just had a head injury, you could use a variety of these.

Darius: Yeah. that's been fantastic. Thank you very much for bringing this topic up.

Erica: Yeah, it's interesting, isn't it?

Darius: Yeah. So what do people do next if they're listening to this? It sounds to me like going and giving your screener a shot would be a good idea. How much is it when you say not very expensive?

Erica: I think it's $15 for the assessment. If you want to have access to the full user dashboard and training, then you would have to pay a little extra for that. What I have done is that if you're, say a teacher or a parent and you want to buy a few of them, then you can get access to everything. But I think, some people just want to do the screener. If they just want to do the screener and get the report, then I think it's $15.

Darius: Yeah, but the main point is it's not like a couple of $100. It's just a few bucks.

Erica: Yeah, it's not bad.

Darius: All right, erica. Next. Oh, and do you know what? I really love your suggestion. Something you mentioned in here was time, and we're going to be talking about time blindness in one of our future episodes just to whet your appetite that we're going to be talking about time, which is a huge element in executive function as well.

Erica: And finally, I just want to let everybody know that we're going to have links to all the different screeners in the show notes. So if you want to find some direct links, some of them will just be links to information about them, because some of them are just I'm talking about the type of test, so it won't send you to the actual test and it'll just explain to you more about what this type of test does. Because there are a variety of ones that match that type at some point in the future.

Darius: Let's not talk about it now because we'll have another half hour conversation. But I think if you could take the test report that you got, put it into Chat GPT or Claude, that would be a fascinating exercise on how Claude or Chat GPT might interpret that test for you to help you understand it and access it more.

Erica: Yeah, interesting. All right, it's always a pleasure, and I guess we'll see you next week. Thank you for joining our conversation here at the Personal Brain Trainer podcast. This is Dr. Erica Warren and Darius Namdaran

Darius: Check out the show notes for links to resources mentioned in the podcast, and please leave us a review and share us on social media. Until next time. Bye.

#53 Navigating Executive Function Tests and Screeners

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