Test Protocol Booklet

May 2008

Executive Function Performance Test

Carolyn M. Baum, Tracy Morrison,
Michelle Hahn, Dorothy F. Edwards


Program in Occupational Therapy
Washington University School of Medicine
St. Louis, MO
USA





We have had the review and consultation from many colleagues in the development of the
EFPT. We particularly want to acknowledge Heidi Schambra, Research Assistant and now
physician, for her early work on the instrument; Noomi Katz, PhD, OTR and Adina Hartman
Maeir, PhD, OT from Hebrew University; Naomi Josman, PhD, OTR from Haifa University in
Israel; Deirdre Dawson, PhD, OT(C), the Rotman Centre in Toronto and Jen Murawski, MSOT
from Washington University for their contributions to the conceptual development of the
instrument. Much of the work that developed the EFPT was funded by the James S. McDonnell
Foundation Grant No. 21002032.


Baum, Morrison, Hahn & Edwards, 2008



Preface
The Executive Function Performance Task was developed at the Program in
Occupational Therapy at Washington University Medical School in St. Louis, MO. The Kitchen
Task Assessment (KTA), an earlier functional assessment test designed by Carolyn Baum and
Dorothy Edwards (1993), was used as the prototype in developing the EFPT. Like its
predecessor, the EFPT is used to provide a performance-based standardized assessment of
cognitive function (Baum and Edwards, 1993).
Generally, traditional neuropsychological tests follow a bottom-up approach to
analyzing brain function: the tests gather information about specific aspects of cognition, such
as memory, attention, or planning (Duchek, 1997). Although this micro-level assessment gives
an accurate depiction of specific cognitive impairments, the relationship between components
of cognition and overall functional ability is unclear. Conversely, the EFPT takes a macro-level
view of cognition: functioning as a whole is examined as individuals perform an entire task. It
cannot be assumed that impairment in a cognitive process will result in an impairment in
overall functional capacity (Abreu et al., 1994h, Lowenstein et al., 1995). Therefore, it is
unwise to base an intervention strategy solely on the results of a neuropsychological battery,
which may be insufficient to determine an individuals overall ability to function. The results of
the bottom-up tests should be supplemented with top-down performance based assessments.
More insightful interventions can be created with a combination of these two assessment
strategies.
The EFPT, a top-down performance assessment test, was designed to examine total
cognitive integration and functioning in an environmental context. The EFPT specifically
examines executive functions. Executive functions are a group of cognitive processes which
mediate goal-directed activity (Kaye et al., 1990; Stuss, 1992). Thus executive functions are
involved in task execution.
The EFPT serves three purposes:
(1) to determine which executive functions are impaired.
(2) to determine an individuals capacity for independent functioning.
(3) to determine the amount of assistance necessary for task completion.
Unlike other tests of function, the EFPT does not examine what individuals cannot do.
Rather, it identifies what they can do, and how much assistance is needed for them to carry
out a task. The EFPT does not simply discriminate between individuals who can do the test and
those who cannot. By using a cueing system, a wider range of abilities are captured in people
previously thought to be untestable. This cueing system is standardized and associates with
the degree of cognitive impairment. Finally, the cueing system gives the tester a
straightforward assessment of the assistance that the individual will require to safely perform
tasks.
The EFPT examines the execution of four basic tasks that are essential for self-
maintenance and independent living: simple cooking, telephone use, medication management,
and bill payment. The EFPT assesses an individuals ability to complete the following
components of the task (an elaboration of definitions is given in Table 1):
initiation of task
execution of task (requiring organization, sequencing, and judgment and safety)
completion of task
During each task, cognitive functions fluidly interact and co-occur. The rater observes
task performance, focusing specifically on executive functions. The level of cueing necessary to
support task performance is recorded as a score. Thus, the score reflects the participants
capacity for executive functioning that has been observed during performance of each task.
For example, if the individual is unable to initiate the task, the rater can determine that the
executive function underlying initiation is defective and plan a strategy to address this deficit.
Steps are the discrete movements which, cumulatively, comprise an action. Actions, in
turn, are combined to perform the task (Christiansen and Baum, 1997, p. 57). For example, an
individual will reach for a spoon, grasp it, pick it up, place it in the oatmeal, and move it in a
circular motion (the steps) in order to stir oatmeal (the action). At a fundamental level, the
execution of a task requires the ability to correctly sequence and attend to steps, as well as the
abilities to organize tools and utilize judgment to ensure safety. These requirements must be
met in order for successful task completion.
Initiation, execution, and completion have been operationally defined to guide the
development of this test. Using these definitions, the rater is able to analyze the executive
functions that mediate each task. Accordingly, the EFPT allows the rater to observe how
executive functioning is impaired in the individual, and the type and amount of help needed to
maintain self-sufficiency can be ascertained and shared with caregivers.
The EFPT is a formal cognitive test which requires strict adherence to testing protocol.
There should be no modifications of the instructions. Any deviation from standard testing
procedure will decrease validity. In order to avoid bias, the rater must not form preconceived
ideas about the participants capacity to perform the tasks. All test items must be
administered regardless of the participants preferences or experiences towards/with task
items. The EFTP was designed to accommodate all levels of functioning and to establish the
levels of support needed for a range of tasks. Therefore, all participants can be scored on this
measure, especially because it is possible to score when physical assistance is provided and
when the person is not able to perform the task.



Table 1
Executive
Function
Component

Definition

Expected Behavior
Initiation the advent of motor activity that commences a task (DePoy
et al., 1990; Kaye et al., 1990; Weld & Evans, 1989).*
The individual moves to the
materials table to collect items
needed for the task.
Execution the proper completion of each step, consisting of three
requirements: organization, sequencing, and safety and
judgment (see below).
The individual carries out the steps
of the task without incident.
Organization the physical arrangement of the environment, tools, and
materials to facilitate efficient and effective performance
of steps (Weld & Evans, 1990).
The individual correctly retrieves
and uses the items that are
necessary for the task.
Sequencing the coordination and proper ordering of the steps that
comprise the task, requiring a proper allotment of
attention to each step (Lezak, 1989).
The individual carries out the steps
in an appropriate order, attends to
each step appropriately, and can
switch attention from one step to
the next.
Judgment and
Safety
the employment of reason and decision-making capabilities
to intentionally avoid physically, emotionally, or financially
dangerous situations.
The individual exhibits an
awareness of danger by actively
avoiding or preventing the creation
of a dangerous situation.
Completion the inhibition of motor performance driven by the
knowledge that the task is finished (Baum and Edwards,
1993).**
The individual indicates that he/she
is finished or moves away from the
area of the last step.


* It is important to make the distinction between a motor action that begins the task and a motor action that
precedes the task. An excess of the latter is considered self-regulation deficit, a dissociation between intention
and action. In this case, the individual will talk about a task or make gesticulations that resemble movements
needed later in the task (e.g., stirring motion, hand wringing), but he or she will not carry out the task (Lezak,
1989).
** Two cognitive factors may contribute to difficulty in completing a task: (1) an inability to disengage attention
from the final step, i.e., acknowledgment that the task is complete, or (2) perseveration, an inability to disengage
motor response from the task (Lezak, 1989). Both factors may lead to a persistence in continuing the task.
Cueing Guidelines:

Unless the participant is in danger (e.g., putting the pitcher of water down where it could
fall off the table and break, putting a hot pad on the burner, touching the burner to see if it
is on, placing their sleeve in the fire, etc.), do not intervene until the participant shows
he/she is struggling with the next step.
If the person has difficulty with any aspect of any of the tasks, you must wait at least 10
seconds (to observe processing) before giving the participant a cue.
Give two cues of each kind before progressing to the next cueing level.
Give cues progressively (see below) from verbal guidance gestural guidance direct
verbal assistance physical assistance. If the participant is still unable to perform a step in
a task, the examiner should do the step for him/her, then the participant should be cued
back to the next sequential step of the task.
You will often find yourself combining different levels of cues. The score of your degree of
assistance must reflect the highest level of cue used to get the task done.
Do not initiate conversations during the test, and do not cheer lead, i.e., do not give
positive or negative feedback.

Cueing Descriptions:

No Cues Required: The participant requires no help or reassurance, does
not ask questions for clarification, goes directly to the
task and does it. Self-cueing is acceptable. Ex. speaking
to oneself
Indirect Verbal Guidance: The person requires verbal prompting, such as an open-
ended question or an affirmation that will help them
move on. Indirect verbal guidance should come in the
form of a question, not a direct instruction, e.g.: What
should you do now?; What is the next step?; What
else do you need? Avoid direct phrases such as read
the instructions or turn on the stove.

Gestural Guidance: The person requires gestural prompting. At this level,
you are not physically involved with any portion of the
task. Instead, you should make a gesticulation that
mimics the action that is necessary to complete the
subtask, or make a movement that guides the
participant, e.g., you may move your hands in a stirring
motion, point to where the participant may find the
item, point to the appropriate level on the measuring
cup, etc. You may not physically participate, such as
handing the participant an item.
Direct Verbal Assistance: You are required to deliver a one-step command, so
that you are cueing the participant to take an action.
For example, say, pick up the pen or pour the water
into the pan.
Physical Assistance: You are physically assisting the participant with the step,
but you are not doing it for him/her. You may hold the
cup while he/she pours, hold the check book while
he/she writes, loosen the cap on the medicine
container, etc., but the participant is still attending to
and participating in the task.
Do for the Participant: You are required to do the step for the participant.

Frequently asked questions:

How do you deal with a cuing family member? How do you score if the family member "jumps
in"?

Prior to starting the test tell the family member that they may observe but that they may not
make comments or come into the area where the testing is being performed. Note: In my experience
it is often helpful for the family member to observe what it takes for the person to perform the task.
But they should not interfere. If they do, stop the test and ask them to leave the area.


How do you score if a client refuses to do one subtest?

You have told them in the beginning that these are tests and that they may or may not
do them in their own daily lives. Take the time to explain that it is important to have
information on all of the tests and use your persuasion to help them proceed. Ask them if they
want to do another test before coming back to the one that they are not anxious to do.

How do I differentiate physical assistance because of a motor deficit vs. physical assistance
from a cognitive deficit?

This requires clinical reasoning on the part of the administrator. You may ask the person
to tell you what they need you to do to help them with the task because of a physical
limitation. You do not record it as needing physical assistance because they knew what to do
and asked you to help them.

EFPT Supplies Needed
All of these items are in a clear rectangular box large enough for the items all to be seen. The
box is placed on a surface where the person must go to retrieve the items they need for the
task and place them outside of the box before beginning the task.

Hand soap in dispenser (as one would find in a home)
Towel
Pan (with handle that gets hot and requires a pot holder)
Pot holder
Measuring cup (glass) 1 cup
Dry measuring cups
Spoon for stirring
Rubber spatula
Old-fashioned Oats
Enlarged copy of the instructions for the stovetop version only
Bowl
Spoon for eating
Salt shaker
Timer a timer with a dial rather than a digital timer
Pencil
Paper
Phone book
Magnifying Glass
Medicine bottle with instructions on it- with the persons name on it filled with sugar-free
candy
Medicine bottle as a distractor (another persons prescription) filled with sugar-free candy
Claritin bottle (non prescription) as a distractor filled with sugar-free candy
Drinking cup
Two bills (one cable bill, one phone bill with pre addressed envelopes) mixed with 5 other
pieces of mail (letter from credit card company, postcard, flier, letter in a plain white envelope,
mail order catalog.) in a Ziploc bag. Note the dates due on the bills should differ, one due upon
receipt and one due 30 days from receipt.
Checks in a check register (obtained from a bank)
Balance sheet (i.e., account book) with a balance $5.00 less than the bills total
Pen
Calculator
Other distracter items:
Tongs
Pepper shaker
Restaurant / apartment guide
Catalog

PRETEST CHECKLIST


All necessary items are in box (as indicated above)


New check registry has been placed in checkbook


Balance is indicated in check registry


Pill bottle is labeled with subjects name


Envelopes have return address labels


Directions for the EFPT

The tasks should be carried out in the following order*:
Hand Washing (Score Sheet A) Only use this task if the person has severe cognitive
impairment and you want to see if they can follow directions. If they cannot complete the
task of washing their hands do not proceed with administration. STOP THE ASSESSMENT AT
THIS POINT. We do not score the handwashing task when reporting the scores in analysis.
Oatmeal Preparation (Score Sheet B)
Telephone (Score Sheet C)
Taking Medication (Score Sheet D)
Paying Bills (Score Sheet E)
Be sure that the area is clear of other items so there is room for the participant to work.

*If the participant refused to do a particular task (except the hand washing), the task can be
skipped and done later. Be sure they know this is an assessment and that they will complete
four tasks as a part of the assessment.

Administering the Assessment

1. Begin the EFPT with the script and the pre-task questions.
2. Leave all of the items necessary for all of the tasks in the box on a table (the materials
table).
Bills and mail should be mixed together in a Ziploc bag. The account/check book should have
checks included inside. [All other items are loose in the box.]
3. Ask the person to begin the task (use the script)
4. Offer assistance only after the participant has made a good attempt to process the actions
necessary to carry out the step. The cueing guidelines should be used.
5. Complete the cueing chart and behavior assessment chart for each task.



Script
Today Ill be asking you to wash your hands, make some oatmeal, use the telephone, take
some fake medication, and pay some fake bills. You may not be doing these tasks at home,
but they have been selected for this test as representing those most like daily tasks. If you need
help at any point in this test, let me know.

All the items you need to do these tasks are here in the box (show it to them). I want to know
a few things about you before I begin the testing, so Im going to ask you a few questions.
Please answer them as best as you can. This card should guide your responses (show the
participant the response card and read directly from it).

Pre-Test Questions

Will you be able to wash your hands?
0= by yourself.
1= with verbal guidance
2= with physical assistance
3= I wont be able to do this task

Do you cook? 1= Yes 2= No
Do you use the stove to cook meals?
1= Yes 2= No
Have you recently made oatmeal on the stove? 1= Yes 2= No

Will you be able to make oatmeal?
0= by yourself.
1= with verbal guidance
2= with physical assistance
3= I wont be able to do this task

Do you use the phone on a regular basis? 1= Yes 2= No
How many times a week do you use the phone? __________________
What is the phone number you call in an emergency? ______________
1= correct 2= incorrect

Will you be able to make a phone call . . .
0= by yourself.
1= with verbal guidance
2= with physical assistance
3= I wont be able to do this task

Do you take medication? 1= Yes 2= No
Can you show me where you keep your medications? 1= Yes 2= No

When do you take your medicine? __________________________
1= morning
2= afternoon
3= evening
4= before bed
5= more than once a day
Will you be able to take medicine?
0= by yourself.
1= with verbal guidance
2= with physical assistance
3= I wont be able to do this task

Do you pay your bills? 1= Yes 2= No
Does someone help you with your bills? 1= Yes 2= No

Will you be able to pay these bills?
0= by yourself.
1= with verbal guidance
2= with physical assistance
3= I wont be able to do this task



EXECUTIVE FUNCTION PERFORMANCE TEST

Task: Hand washing

Items required for task:
Hand soap in dispenser (as one would find in a home)
Towel

Commence Task:

I want to see you wash your hands with soap. The items you will
need are in the box.

Executive Function Performance Test (EFPT): Form A
TASK: Hand Washing Independent

0
Verbal
Guidance
1
Gestural
Guidance
2
Verbal Direct
Instruction
3
Physical
Assistance
4
Do For
Participant
5
Score
INITIATION: beginning the task.
Upon your request to start, participant moves to
table to gather tools/materials for washing hands.
____
EXECUTION: carrying out the actions of the task
through the use of organization, sequencing, and
judgment.

Organization: arrangement of the tools/materials to
complete the task.
Participant retrieves the items needed (hand soap,
towel).
____
Sequencing: execution of steps in appropriate order.
Participant performs steps in appropriate sequence,
e.g., turns on water, picks up soap, lathers hands,
rinses hands, turns off water, reaches for towel, and
dries hands.
Participant does not confuse steps, e.g., dries hands
before washing them, uses soap before hands are
wet, etc.
____
Judgment & Safety: avoidance of dangerous
situation.
Participant prevents or avoids danger, e.g., water
temperature is not scalding, avoids water spills on
the floor, does not eat soap, etc.
____
COMPLETION: termination of task.
Participant knows he/she is finished, e.g., stops
drying hands/turns off water.
____

Total Score ___________
EXECUTIVE FUNCTION PERFORMANCE TEST

Task: Simple Cooking

Items required for task:
Pan (with handle that gets hot and requires a pot holder)
Pot holder
Measuring cup (glass) 1 cup
Dry measuring cups
Spoon for stirring
Rubber spatula
Old-fashioned Oats
Enlarged copy of the instructions for the stovetop version only
Bowl
Spoon for eating
Salt shaker
Timer a timer with a dial rather than a digital recording


Commence Task:

I want you to make oatmeal. Here is an enlarged version of the
instructions (hand to participant). Follow these directions and when
you are done, put the oatmeal in a bowl. The items you need are in
the box.

Note: The participant should not be penalized if he/she does not clean the bowl or pan.

Executive Function Performance Test (EFPT): Form B
TASK: Simple Cooking Independent

0
Verbal
Guidance
1
Gestural
Guidance
2
Verbal Direct
Instruction
3
Physical
Assistance
4
Do For
Participant
5
Score
INITIATION: beginning the task.
Upon your request to start, participant moves to table to
gather tools/materials for making oatmeal.
____
EXECUTION: carrying out the actions of the task through the use
of organization, sequencing, and judgment.

Organization: arrangement of the tools/materials to complete
the task. Participant retrieves the items needed (pan, pot
holder, measuring cup, oats, instructions, spoon).
____
Sequencing: execution of steps in appropriate order.
Participant performs steps according to the directions
participant measures water, puts water into pan, turn on
stove, sets heat according to what is needed, boils water,
measures oats, puts oats into boiling water, stirs, turns off
stove, uses pot holder to lift hot pan, and pours oats into
bowl.
Participant does not confuse steps, e.g., turns off stove before
water boils, replacing oats in cupboard before measuring
some out, but may measure oats before boiling the water or
put salt in the water before or as it boils.

____
Judgment & Safety: avoidance of dangerous situation.
Participant prevents or avoids danger, e.g., turns water off,
does not lay pot holder near burner, turns burner off, uses
pot holder to lift hot pan, etc.
____
COMPLETION: termination of task.
Participant knows he/she is finished, e.g., pours oatmeal into
bowl and moves away from pot. If participant washed dishes,
he/she moves away from the sink, doesnt continue to scrape
the pan, etc.
____

Total Score _______
EXECUTIVE FUNCTION PERFORMANCE TEST

Task: Using the Telephone

Items required for task:
Pencil
Paper
Phone book
Magnifying Glass


Commence Task:

I want you to look up a local grocery store in the phone book,
telephone them, and ask them if they deliver groceries. Let me know
what you find out. The items you need are in the box.

Executive Function Performance Test (EFPT): Form C
TASK: Using the Telephone Independent

0
Verbal
Guidance
1
Gestural
Guidance
2
Verbal Direct
Instruction
3
Physical
Assistance
4
Do For
Participant
5
Score
INITIATION: beginning the task.
Upon your request to start, participant moves to table
to gather tools/materials for making a phone call.
____
EXECUTION: carrying out the actions of the task through
the use of organization, sequencing, and judgment.

Organization: arrangement of the tools/materials to
complete the task.
Participant retrieves the items needed (phone book,
pencil, paper).
____
Sequencing: execution of steps in appropriate order.
Participant performs steps in appropriate sequence,
e.g., looks up number, lifts receiver, dials number,
reaches correct number, and tells you the correct
answer.
Participant does not confuse steps, e.g., dials number
before looking it up, hangs up receiver in middle of
dialing, puts away phone book instead of looking up
number, etc.
____
Judgment & Safety: avoidance of dangerous situation.
Participant prevents or avoids danger, e.g., dials the
correct number, reports information accurately to you,
replaces receiver on hook so phone can be used, etc.
____
COMPLETION: termination of task.
Participant knows he/she is finished, e.g., hangs up
phone and does not continue pushing buttons.
____

Total Score____
EXECUTIVE FUNCTION PERFORMANCE TEST

Task: Taking Medication

Items required for task:
Medicine bottle with instructions on it with the persons name on it filled with sugar-
free candy
Medicine bottle as a distractor (another persons prescription) filled with sugar-free
candy
Claritin bottle (non prescription) as a distractor filled with sugar-free candy
Drinking cup
Magnifying Glass


Commence Task:

I need you to pretend you have a prescription in the box. Find your
prescription and do what the instructions tell you to do. The pills in
the bottle are safethey are sugar-free candy.

After they take the drug, ask the following questions in order to rate judgment and safety:

What times during the day are you supposed to take this medicine?

__________________________________________________________________________

What are you supposed to take with this medicine?

__________________________________________________________________________

What do you need to be careful of when you take this medicine?

__________________________________________________________________________

Note: it is OK if they chew the pill.

Executive Function Performance Test (EFPT): Form D
TASK: Taking Medication Independent

0
Verbal
Guidance
1
Gestural
Guidance
2
Verbal Direct
Instruction
3
Physical
Assistance
4
Do For
Participant
5
Score
INITIATION: beginning the task.
Upon your request to start, participant moves to table to
gather tools/materials for taking medication.
____
EXECUTION: carrying out the actions of the task through the
use of organization, sequencing, and judgment.

Organization: arrangement of the tools/materials to
complete the task.
Participant retrieves the items needed (medicine bottle,
instructions, pills, glass).
____
Sequencing: execution of steps in appropriate order.
Participant performs steps in appropriate sequence, e.g.,
reads the directions on the pill bottle, opens pill bottle,
pours pills into hands or onto table, chooses correct
number of pills according to prescription, puts unused
pills back into bottle, puts pills into mouth, swallows, and
puts cap back on bottle.
Participant does not confuse steps, e.g., puts cap on
before takes pills out and counts them, drinks all the
water before puts pills into mouth, etc.
____
Judgment & Safety: avoidance of dangerous situation.
Participant prevents or avoids danger, e.g., takes correct
pills, counts and takes correct number of pills, doesnt put
water too near to the edge of table, doesnt pour water
outside of the cup, etc.
____
COMPLETION: termination of task.
Participant knows he/she is finished, e.g., moves away
from the task, doesnt open pill bottle and play with pills,
etc.
____
Total Score ____
EXECUTIVE FUNCTION PERFORMANCE TEST

Task: Paying Bills

Items required for task:
Two bills (one cable, one phone) mixed with 5 other pieces of mail (letter from credit card
company, announcement of a sale, etc.) in a Ziploc bag
Checks
Balance sheet (i.e., account book) with a balance $5.00 less than the bills total
Pen
Calculator
Note: One of the bills in due upon receipt, the other is due in 30 days so they need to review
both bills before they start to pay one. This may require cues

Commence Task:

I want you to take what you need to pay the bills out of the bag, find
the bills, pay them, and balance the account. These are fake bills and
this is not your account but I need you to pretend that these are your
bills and your account as this is part of the assessment.

Note: use of the calculator is not mandatory.

Executive Function Performance Test (EFPT): Form E
TASK: Paying Two Bills Independent

0
Verbal
Guidance
1
Gestural
Guidance
2
Verbal Direct
Instruction
3
Physical
Assistance
4
Do For
Participant
5
Score
INITIATION: beginning the task.
Upon your request to start, participant moves to table to
gather tools/materials for paying two bills.
____
EXECUTION: carrying out the actions of the task through the
use of organization, sequencing, and judgment.

Organization: arrangement of the tools/materials to
complete the task. Participant retrieves the items needed
(pen, checkbook, bills, envelope, stamp).
____
Sequencing: execution of steps in appropriate order.
Participant performs steps in appropriate sequence, e.g.,
locates the bill, checks the balance, writes the check for
the correct amount, puts check into envelope and
addresses it, puts stamp onto envelope and seals it,
locates second bill, checks balance, etc.
Participant does not confuse steps, e.g., writes check
before checking the balance, seals envelope before
putting check in, puts check into envelope before signing
it, etc.
____
Judgment & Safety: avoidance of dangerous situation.
Participant prevents or avoids danger, e.g., makes check
out in the correct amount and signs it, writes correct
address, subtracts check amount from the balance,
doesnt write second check (or indicates in some way that
there are insufficient funds in the account to write the
second check), etc.
____
COMPLETION: termination of task.
Participant knows he/she is finished, e.g., puts down the
checkbook, doesnt continue writing checks or fussing
with the bills or checkbook, etc.
____

Total Score ____
To Score the test: Total all Initiation, Total all Organization, Total All Sequencing, Total All
Judgment & Safety, Total All Completion to see the area of most concern, then make a grand
total.

SCORING THE EFPT

The highest level of cueing necessary to support the performance of the four
instrumental tasks (hand washing is not scored as it is a screening tool) is recorded; thus, the
test results in three scores, the executive function (EF) component score, the task score, and a
total overall score. The EF component score is calculated by summing the numbers recorded
on each of the four tasks for initiation, organization, sequencing, judgment and completion.
Each EF component can range from 0 to 5 with a total of all four tasks ranging from 0-20. The
second score is the task score; this is calculated by summing the five scores for each task. The
range for each task is 0 to 25. The total score is the sum of the performance on all four tasks
with a total score of performance on all four tasks that can range from 0 to 100.




REFERENCES
Abreu, B., Duval, M., Gerber, D. & Wood, W. (1994). Occupational performance and the
functional approach. In C.B. Royeen (Ed) AOTA self-study series: Cognitive
rehabilitation. Rockville, MD, American Occupational Therapy Association.
Baum, M.C., Edwards, D. (1991). Cognitive performance in senile dementia of the Alzheimers
type: The kitchen task assessment. American Journal of Occupational Therapy
1993;47(5):431-436.
Christiansen, C. (1991). Occupational therapy: Intervention for life performance. In (eds)
Christiansen, C. & Baum, C. Occupational therapy: Overcoming human performance
deficits. Thorofare, New Jersey: Slack, 4-43.

Christiansen, C. & Baum, C.M. (1997). (Eds.) Occupational therapy: Enabling Function and
Well-Being (2nd Ed.). Thorofare, NJ: Slack.
DePoy, E. et al. (1990). Executive function and cognitive remediation: a study of activity
preference. Occupational Therapy Approaches to Traumatic Brain Injury. Haworth Press,
Inc., New York.

Duchek, J.M. & Abreau, B.C. (1997). Meeting the challenges of cognitive disabilities. In
Christiansen C & Baum CM: (Eds.) Occupational therapy: Enabling Function and Well-
Being (2nd Ed.). Thorofare, NJ: Slack.
Kaye, K. et al. (1990). Prediction of independent functioning and behavior problems in
geriatric patients. JAGS: 38, 1304-10.
Lezak, M. (1989). Assessment of Psychosocial Dysfunctions Resulting from Head Trauma.
Assessment of the Behavioral Consequences of Head Trauma. Lezak, M., ed.; Alan Liss,
Inc., New York.
Loewenstein, D. et al. (1995). Neuropsychological test performance and prediction of
functional capacities among Spanish-speaking and English-speaking patients with
dementia. Archives of Clinical Neuropsychology: 10 (2), 75-88.
Stuss, D. (1992). Biological and Psychological Development of Executive Functions. Brain and
Cognition: 20, 8-23.

Weld, E. & Evans, I. (1990). Effects of part versus whole instructional strategies on skill
acquisition and excess behavior. Am. J Mental Retardation: 94 (4), 377- 86.