Executive Function Performance Test

Overview

Author(s): Baum, C.M., Morrison, T., Hahn, M., & Edwards, D.F.

Year of Publication: -

Publisher: Program in Occupational Therapy at Washington University Medical School in St. Louis, MO

Type of Assessment: 

• Standardized

• Performance-based

• Observation-based

• Criterion-referenced

Cost: Free for the assessment (authors request that when used, you email to report the reason for use) but costs for items varies 

How to Access: https://www.ot.wustl.edu/about/resources/executive-function-performance-test-efpt-308 

Age: Adolescents (13-17), Adults (18-64), Geriatrics (65+)

Diagnoses: stroke, MS, brain injury, mental health challenges, neurocognitive disabilities

Setting: home health, outpatient rehab, SNFs, (*areas with a stove top)

Areas Assessed:

Self-maintenance & independent living

• Handwashing *only if severe cognitive impairment applies

• Simple cooking (oatmeal)

• Telephone use

• Medication management

• Bill payment

Administration

Time: 30-45 mins

Group/Individual: Individual

Subtests: 20 items within 4 subtests

Instructions: Complete pre-test checklist and item preparation while using the script to describe the assessment and conduct pre-test questions. Refer to the training manual to instruct IADL tasks

• 1) making oatmeal

• 2) looking up a grocery store phone # and calling to ask if they deliver groceries

• 3) taking proper dosage of correct medication

• 4) paying two bills

• *Activities must be completed in the order that was described

• Provide assistance only after attempt has occur and curing should start at the lowest level throughout steps of each task 

• Conversations & +/- feedback to clients cannot happen so other individuals are not permitted to be involved

• *Can only be administered once per client (learning effect can impact results after repeated completion)

Materials: manual, 32 designated household items plus several distracter items stored in a box including a bowl, salt-shaker, phone book, magnifying glass, etc.

User Qualifications: Manual review 

Scoring Procedures

How to Score: There will be a total of 3 scores

• The highest level of cueing needed for each of the 5 components of executive function is recorded in each task

  • EF scores range from 0-5

• All levels of cueing should be totaled to range from 0-25

• A total of all 4 task scores are summed

• In addition to cueing, the duration of each task (in minutes) should be recorded

Score Indications:

• Higher EF scores = higher levels of cueing needed

Psychometrics

Reliability: 

• Interrater reliability: Excellent

  • Overall: ICC =0.91

  • Cooking: ICC = 0.94

  • Paying Bills: ICC = 0.89

  • Medication: ICC = 0.87

  • Using Phone: ICC = 0.79

• Internal consistency: Mixed

  • Excellent - Overall: Cronbach's alpha = 0.94

  • Excellent - Cooking: Cronbach's alpha = 0.86

  • Excellent - Med Management: Cronbach's alpha = 0.88

  • Adequate - Paying Bills: Cronbach's alpha = 0.78

  • Adequate - Telephone: Cronbach's alpha = 0.77

Validity: 

• Concurrent Validity: Mixed

  • Excellent - FAM: r=-0.68

  • Excellent - AMPS: r=0.61

  • Adequate - FIM: r=-0.40

  • Adequate - Short Blessed: r=0.39

  • Adequate - Wechsler Memory Scale: r=-0.59

• Construct Validity:

  • Adequate - DKEFS Sorting: r=-0.51

  • Adequate - DKEFS Color-Word: r=-0.566

  • Adequate - Short Blessed: r=0.548

• Criterion Validity:

  • Adequate - TOL-DX: r=.379

• Content Validity: developed based on C. Baum's KTA measure of functional ability

Pros & Cons

Strengths:

• Observes capabilities and cognitive deficits through a top-down approach, assessing how this impact actual occupational performance

• Allows the test administrator to actively assess the type of assistance needed during task completion, rather than having the client fail portions of the assessment

• It can be used with adolescents, adults, and elderly adults, including those with motor impairments

• It uses a standardized cueing system that enables use with individuals of varying abilities

• Assesses performance on four functional tasks (cooking, telephone use, medication management, and bill payment), which are relevant to daily life

• Korean version available (EFPT-K) to be more culturally appropriate & translated into Swedish

Weaknesses:

• Time-consuming

• Can only be administered once due to confounds of a learning effect during second administration

• It does not provide adjustments for visual impairments or hearing limitations

• Does not have standardized equipment that has been tested with a variety of populations

• Not suitable for use with individuals with severe cognitive impairment who are unable to follow directions

References

• Asher, I. E. (2014). Asher’s occupational therapy assessment tools: An annotated index (4th ed.). AOTA Press

• Baum, C.M., Connor, L.T., Morrison, T., Hahn, M., Dromerick, A.W., Edwards, D.F. (2008). Reliability, validity, and clinical utility of the Executive Function Performance Test: a measure of executive function in a sample of people with stroke. American Journal of Occupational Therapy, 62(4), 446-455. 

• Shirley Ryan Ability Lab. (2019, August 1). Executive function performance test. https://www.sralab.org/rehabilitation-measures/executive-function-performance-test 

• WashU Program in Occupational Therapy. (n.d.). Executive Function Performance Test (EFPT). Washington University Medicine. https://www.ot.wustl.edu/about/resources/executive-function-performance-test-efpt-308