CHAPTER 53: EXECUTIVE FUNCTION PERFORMANCE TEST (EFPT)

Description

The Executive Function Performance Test (EFPT) is designed to quantify the amount of assistance necessary for an individual to carry out specific daily tasks and is loosely based on the Kitchen Task Assessment described in Chapter 86. However, the EFPT replaces the task of preparing cooked pudding with preparing cooked oatmeal along with three other activities: completing a telephone call, managing medication, and paying a bill (Baum et al., 2008; Baum & Wolf, 2013). The EFPT examines executive functions in the context of performing a task and serves three purposes: (1) to determine which executive function components are deficient during task engagement; (2) to determine an individual’s capacity for independent functioning; and (3) the amount and type of assistance necessary for completion of the task (Baum, Morrison, Hahn, & Edwards, 2007; Baum & Wolf, 2013). This is done by assessing client performance relative to five domains: (1) the client’s initiation of a task (beginning the task); (2) organization (retrieval and arrangement of tools); (3) sequencing (execution of steps in the correct order); (4) safety and judgment (avoids a dangerous situation); and (5) completion (Baum & Wolf, 2013). The assessment employs a unique standardized system of cueing in order to capture the functional abilities of people during tasks across those domains and is based on the progressive need for assistance associated with varying levels of cognitive impairment thereby giving the clinician a way to record the amount of assistance required to successfully perform the task. (Baum & Wolf, 2013). Amount and type of cues are then factored into scoring descriptors from (0) no cues required to (5) physical assistance or do the task for the participant. Higher scores are reflective of the need for more cueing and is associated with more severe deficits. The EFPT can be completed in 60 minutes or less.

Psychometrics

Inter-rater reliability, as determined by it’s the creators in a sample of 10 subjects with 3 trained raters was r = 0.91, with subtest intra-class correlation coefficient scores of 0.94 for the cooking task, 0.89 for paying bills, 0.87 for managing medication, and 0.79 for the using the telephone (Baum et al., 2008). Internal consistency of the sample was also high at α = 0.94 with subtest Cronbach’s alpha at 0.86 for the cooking task, 0.78 for paying bills, 0.88 for managing medication, and 0.77 for using the telephone. (Baum et al., 2008). The same study found that the EFPT correlated well among each of the test domains and the total score as follows: initiation 0.91, organization 0.93, sequencing 0.88, safety and judgment 0.78, and completion of all steps 0.89. Significant moderate correlations were also found between the recall score of the Wechsler Memory Scale at r= –0.59, the Short Blessed Scale (r = 0.39), and the Functional Independence Measure (r = –0.40) (Baum et al., 2008). In a study of 30 subjects in acute and chronic stage, 31 schizophrenia researchers found internal consistency reliability to be high at α = 0.88, whereas the correlation coefficients between each executive function component and total scores were initiation 0.71, planning 0.81, transfer between stages 0.87, error detection 0.80, error correction 0.88, safe performance 0.82, and completion 0.53 (Katz, Tadmor, Felzen, & Hartman-Maeir, 2007). The same study found correlations between the individual EFPT tasks and the Behavioural Assessment of the Dysexecutive Syndrome total scores ranged from r = 0.39 to 0.67 within the acute group and 0.33 to 0.63 within the chronic group.

Advantages

The EFPT is located in the public domain, thus it is free to use in clinical practice, research, and publication. No special training is needed and it has been validated in a number of settings. The cueing system can provide helpful insight into the amount of direct supervision needed for successful occupational engagement as well as the ability to test, in a standardized format, populations who otherwise might not be able to be assessed. Washington University—St. Louis maintains a website devoted to the scale where it and supporting information can be downloaded.

Disadvantages

There is a limited amount of direct research in support of its use in clinical practice. The EFPT can take an hour or more to complete and can be involved because it requires an amount of space and material to prepare hot oatmeal such as a stove.

Administration

The EFPT can be used pre- and post-treatment and the examiner’s manual has detailed instructions as well as interpretations for the clinician to follow, which includes several pre-test questions. The test delivers three separate scores: (1) an executive function (EF) component score, (2) a task score, and (3) a total score. The EF component score is calculated by summing the numbers-recorded prompts relative to each of the domains of the task and can range from 0 to 5. The task score is calculated by summing the 5 domain scores for each task and ranges from 0 to 25. The total score is the sum of all domain scores of all 4 tasks and can range from 0 to 100 (Baum & Wolf, 2013). Further scoring interpretations quantifies the practitioner’s clinical judgment of subject performance.

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