Psychometric Properties of the Revised Executive Function Challenge Task (EFCT)

Background:

Children with ASD have flexibility and planning deficits that inhibit their ability to socialize, succeed in mainstream school settings and complete every day tasks. Recent reviews of the literature reveal difficulty consistently capturing these observed executive functioning (EF) deficits with laboratory measures (Kenworthy et al., 2009; Geurts et al., 2009).  We have previously described a treatment sensitive observational measure, the EFCT, which challenges children to be flexible and planful (Kenworthy, Anthony et al., 2014). 

Objectives:  

To investigate the internal consistency and validity of the EFTC and to explore its ability to distinguish children with autism spectrum disorder (ASD) from typically developing children (TDC).

 

Methods:  

30 TDC (age M=10.2 years, SD=1.7; FSIQ M=115.9, SD=11.3) and 63 children with ASD (age M=9.5 years, SD=1.1; FSIQ M=108.3, SD=18.1) were evaluated with a shortened form of the EFCT, three standardized activities on which behavior is coded for flexibility and planning. Examiners achieved inter-rater agreement >90%. Parents completed the Behavior Rating Inventory of Executive Function (BRIEF).

Results:  

Chronbach’s alpha statistics indicate good internal consistency for the EFCT average Flexibility Scale (FS; α=0.79) and Planning Scale (PS; α=0.69) scores, and item total correlations are all in the acceptable range. Convergent validity was demonstrated between the FS and PS and the parent reported BRIEF Shift and Plan/Org scores (r’s > 0.42, p’s < 0.001) for the combined TDC/ASD data. The FS and PS clearly distinguished individuals with ASD from the TDC group (t’s > 7.3, p’s < 0.001). The larger ASD and TDC groups were not matched for age, sex or FSIQ, however. A subset of the ASD (n=20) and TDC (n=20) participants more closely matched for those variables (p’s > 0.39) was investigated regarding EFCT FS and PS scores, revealing significantly greater problems in the ASD than the TDC group (t’s >4.0,p’s < 0.001). See Table. Discriminant function analysis indicated that the EFCT total score correctly classified 85% of the children with ASD and 90% of the TDC children.

Conclusions:  

In addition to showing sensitivity to a cognitive behavioral EF treatment, the EFCT: can be coded reliably; has good internal consistency; distinguishes children with ASD, who are know to have flexibility and planning deficits, from TDCs; and is moderately correlated with parent report of flexibility and planning problems. The EFCT has the potential to capture a unique set of EF behaviors that are important in characterization and treatment research efforts.

Table: Demographic and EFCT Scores ASD and TDC Groups

	Total Sample			Matched Sample
	ASD (N=63)	TDC (N=30)	p value	ASD (N=20)	TDC (N=20)	p value
Male	88.9%	50%	.000	70%	65%	.500
	Mean(SD)	Mean(SD)		Mean(SD)	Mean(SD)
Age in years	9.55(1.1)	10.19(1.7)	.071	9.87(1.3)	9.66 (1.5)	.636
FSIQ	108.32(18.1)	115.87(11.1)	.016	116.10(16.7)	119.85(10.3)	.398
BRIEF Shift	70.25(12.68)	45.10(8.93)	.000	69.80(10.91)	43.75(7.69)	.000
BRIEF Plan/Org	66.35(12.71)	46.93(10.2)	.000	65.75(13.05)	45.55(9.85)	.000
EFCT Flexibility	.97(.59)	.23(.36)	.000	.82(.62)	.18(.33)	.000
EFCT Planning	1.43(.47)	.29(.37)	.000	.90(.34)	.13(.27)	.000
EFCT Composite Score	1.20(.42)	.26(.29)	.000	.86(.40)	.16(.19)	.000