Chapter V.

Executive Function,
Theory pf Mind &
Adapative Behavior
What we'll discuss
The assessment of cognitive function
Theory of mind and mind-blindness theory
ASD and ToM
Historical background of adaptive behavior
Measures of adaptive behavior
Measures of adaptive behavior
 Executive Function
EFs are higher-level cognitive processes
that allow us to respond in an adaptive
manner to the environment: to break out
of habits, make decisions and evaluate
risks, plan for the future, prioritize and
sequence actions, and cope with novel
situations.
 EFs consist of several processes:
(1) anticipation and deployment of attention
(2) impulse control and self-regulation, (3) initiation of
action
(4) working memory (WM)
(5) mental flexibility and utilization of feedback
(6) planning ability and organization
(7) selection of efficient problem-solving strategies
(8) monitoring of performance (Anderson, 2008).
It conceptualizes EF as an overall control system
that consists of four distinct domains:
(1) attentional control
(2) cognitive flexibility
(3) goal setting
(4) information processing.
This model defines three key aspects of
EFs:

(1) working memory capacity (WMC)

(2) shifting (between tasks or mental sets)
(3) inhibition or suppressing a prepotent
respons
2 Classifications of EF
Cold processes are associated with the
prefrontal cortical regions and include
planning cognitive flexibility (CF), WM,
behavioral monitoring, and inhibition
(Chan et al., 2008).
Hot processes are associated with the
orbito-frontal cortices, and mobilize
behaviors that are related to emotional
awareness, for example,empathy and
theory of mind (ToM)
The Awareness of Social Inference
Test (TASIT)
a dynamic audiovisual assessment, to evaluate social
cognition skills required during social interaction.
Performance on social cognition measures, such as TASIT
is likely to be influenced by both hot and cold EFs
(McDonald et al., 2006).
 THE ASSESSMENT OF EXECUTIVE
FUNCTION
Traditionally, EF measures have included novel and complex tasks that
involve the integration of information ( Walsh, 1978). Such tasks require
the examinee to focus, formulate a plan, and employ self-regulation.
Most EF measures are multidimensional and thus examine multiple
cognitive processes, both executive and nonexecutive
(Anderson, 2002). Such multidimensionality complicates the
differentiation among cognitive deficits. One approach to overcome this
limitation is the incorporation of quantitative (e.g., success/failure,
latency, number of errors, and so on), qualitative (e.g., motivation,
attention, concentration, and so on), and cognitive (e.g., process,
strategies, action, and so on.) methodologies (Anderson, 2002).
Parsons and Carlew (2016) provide an example of
controlling modern technology to allow for more
dynamic assessment. Specifically, they utilized
virtual reality to adapt a Stroop-like classroom-
based task incorporating additional demands. They
discovered that including distractions with the task
(which may simulate the disturbing conditions of
real-world contexts) elicits deficits in autism
spectrum disorder (ASD), unlike a task without
distractors.
There are a number of standardized neuropsychological tests
that are widely used in both the clinical and research
arenas to assess EF:

Wisconsin Card Sorting Test

Tower of London/Hanoi
Trail Making Test
Stroop verbal fluency tasks
Negative priming tests
Intradimensional–extradimensional shift tests
Go/No-Go tasks.
 Cognitive flexibility and set
shifting
It appears that cognitive inflexibility deficits are clearly
related to a behavioral rigidity. Thus difficulties can be
observed in modifying strategies during daily activities or
adapting perspectives during social interactions. A general
definition of CF refers to the ability to switch cognitive sets
to adapt to environmental modifications oralterations
(Dennis & Vander Wal, 2010).
Set shifting refers to the ability to shift back and forth
between different tasks, and is considered one of the core
functions of executive processes. This develops
significantly across childhood, as children progress from
following single rules to shifting between two competing
sets of rules (e.g., Bunge & Zelazo, 2006; Chatham, Yerys,
& Munakata, 2012). Successful set shifting is linked with
adaptive and academic functioning in typical development
and in children with ASD (e.g., Lopata et al., 2012;
Pugliese et al., 2015).
 Measures of cognitive flexibility/set
shifting
Review of literature reveals that the findings regarding CF deficits in
individuals with autism are rather inconsistent, despite manifested
behavioral inflexibilty. Several self-report questionnaires have been
developed to evaluate CF in an effort to provide less frustrating and
more time-efficient measures that may provide more utility in a
clinical setting (Dennis & Vander Wal, 2010). According to Geurts,
Corbett, and Solomon (2009) , current measures cannot capture the
multitude or complexity of environmental factors that affect an
individual with autism behavior in daily life. They suggest the use of
ecologically valid measures that could also help in consolidating the
associations between observed behavior and measured CF.
The Intradimensional/Extradimensional (ID/ED) Shift Test
From the Cambridge
Neuropsychological Test Automated Battery
The Intradimensional/Extradimensional (ID/ED) test measures
flexibility in a systematic fashion that allows for controlled
increases in shifting demands ( Cambridge Cognition, 1996). It
consists of nine stages, which encompass three types of tasks:
(1) simple object discrimination; (2) shifting within a single
dimension (e.g., shape: ID shift); and (3) shifting attention from one
dimension to another. Success on the ID/ED test is measured both
by the ability to pass a stage (number of stages completed) and by
the number of errors made while passing a stage (errors to
criterion).
Wisconsin Card Sorting Test (WCST)
The Wisconsin Card Sorting Test (WCST) is a
neuropsychological test that is frequently used to
measure such higher-level cognitive processes as
attention, perseverance, WM, abstract thinking, CF,
and set shifting. It is particularly used in clinical fields
to measure perseverative behaviors that refer to an
individual’s insistence on wrong behavior. Moreover, to
be able to change category, one needs to have high
intellectual flexibility and ability in concept formation.
 Response Inhibition
Response inhibition, the ability to suppress prepotent
behavior that is inappropriate or no longer required, is
critical for goal-directed behavior in everyday life
(Chambers, Garavan, & Bellgrove, 2009). Inhibition is the
most commonly assessed EF process with regard to ASD and
attention-deficit/hyperactivity disorder (ADHD). Response
inhibition is commonly measured with some form of a
continuous performance task that requires withholding a
motor response.
 Measures
Stop-Signal Task and Stop-Signal Reaction Time - The stop-signal
task is a widely used measure of response inhibition and the main
dependent variable of the task, stop-signal reaction time (SSRT),
provides an individualized measure of inhibitory control.
Go/No-Go Task - Go and no-go trials of the task assess processing
speed and response inhibition, respectively (e.g., Brocki Bohlin, 2004).
One of four shapes (circle, square, triangle, or diamond) is randomly
designated as a nontarget for each participant.
The Hayling Sentence Completion Test - The Hayling Sentence
Completion Test ( Burgess & Shallice, 1997 ) aims to detect difficulties
in suppressing prepotent responses, and it consists of two parts.
 Working Memory
The term working memory (WM) has been shaped
through the work of Baddeley and Hitch (1974), who
proposed one of the most influential WM models in
the last century. The concept of WM describes the
temporary storage and manipulation of information
as necessary for complex cognitive tasks like
reasoning or language comprehension (Baddeley,
2000).
 Classification of Working Memory Span
Tasks
Complex span tasks (Daneman & Carpenter,
1980) follow a procedure that is similar to simple
span tasks, with the exception that test takers
are required to complete a simple processing
task (e.g., mathematical operation, symmetry
judgment) between the presentation of each
item.
Schmiedek, Lovden, and Lindenberger (2013) proposed the
following classification of paradigms.
Memory updating paradigm (Salthouse, Babcock, & Shaw, 1991)
comprises tasks in which several elements (e.g., digits or spatial
positions) have to be stored and then simultaneously be updated
according to a series of operations.
Sorting span tasks require the storage of a list of elements
(e.g., letters or objects) and the simultaneous ordering of them
according to some dimension.
N-back tasks require permanently updating memory to store the
last n elements (e.g., digits orspatial positions) of a sequence and
making decisions as to whether the most recent element matches
that one n steps backin the sequence.
 Digit Span Backwards Task
The forward and backward conditions of the Digit Span subtest
from the Wechsler Intelligence Scale for Children–III (Wechsler,
1991) assesses WM storage and updating, respectively. The task
requires that participants listen to a series of digits and repeat the
series in correct forward or backward order. Two trials were
presented at each level of difficulty. Presentation began with two
digits in a series. As the level of difficulty increased, the number of
digits presented in a series increased by one to a maximum of nine.
The test was discontinued when both trials at a given level of
difficulty were incorrectly recalled.
 Comprehensive Measures
The Working Memory Test Battery for Children (WMTB-C; Pickering &
Gathercole, 2001) consists of three subtests designed to assess verbal
WM: Listening Recall, Counting Recall, and Backward Digits Recall.
Wechsler Memory Scale (WMS-IV) - Two batteries were developed for
the WMS-IV: the Adult and Older Adult batteries. The Adult battery can
be used for ages 16–69, and the Older Adult battery is used for
individuals ages 65–90 (either battery can be used in the overlapping
ages of 65–69).
Psychometric Properties of the WMS-IV was standardized on 900
individuals for the Adult battery sample and 500 individuals in the Older
Adult battery sample. The stratification of the normative sample matches
2005 US census data closely on five key demographic variables: age,
gender, race/ethnicity, educational level, and geographic region.
Comprehensive measures of executive
function
A comprehensive assessment of EF
calls for the administration of multiple
measures that collectively assess all
executive domains and preferably
across various modalities.
The Cambridge Neuropsychological Test Automated Battery
(CANTAB) is a computerized neuropsychological as-sessment
battery originally written and developed by Barbara Sahakian,
Trevor Robbins, and coworkers at Neurodevelopmental Disorders
University in the 1980s. The first aim of CANTAB was to assess the
patterns of cognitive decline in dementia in elderly individuals.
However, it has been used in a wide variety of clinical
populations with different levels of ability and ages. It has also
been employed in neuro -psychological research across age
groups to study the development of a set of cognitive functions.
CANTAB incorporates a wide variety of executive and memory
tasks that are adapted for use with humans in paradigms
developed from the evaluation of damage to specific brain
areas in experimental animals (Lowe & Rabbitt, 1998),
especially damage to temporal and frontal cortical regions. The
relationships between the scores on component tests of
CANTAB and evidence of impairment in specific cognitive
functions and psychiatric disorders have been demonstrated in
a very extensive set of data. The CANTAB includes the
following modules: (1) Psychomotor Coordination and Motor
Speed, (2) Reasoning and Planning Abilities, (3) Memory,
and (4) Attention.
The Behavior Rating Inventory of Executive Function (BRIEF;
Gioia, Isquith, Guy, & Kenworthy, 2000) is an 86-item parent
report questionnaire designed to assess executive functioning in
children aged 5–18 years. BRIEF is a questionnaire developed for
parents and teachers of school-age children and designed to
assess the abilities of a broad range of children and
adolescents. The BRIEF is useful when working with children who
have learning disabilities and attention disorders, traumatic
brain injuries, lead exposure, pervasive developmental disorders,
depression, and other developmental, neurological, psychiatric,
and medical conditions.
The Comprehensive Executive Function Inventory (CEFI;
Naglieri & Goldstein, 2013) is a new EF rating scale for
children and youths ages 5–18 years. The CEFI strives to
accurately assess EF abilities based on self, parent, and teacher
reports, and provides specific and individualized intervention
recommendations. The CEFI assesses behaviors that are
associated with EF (e.g., inhibitory control, WM), and determines
an individual’s profile of EF strengths and weaknesses. The CEFI
provides an overall full-scale executive functioning standard
score and individual subtest standard scores on nine
components of EF: Attention, Emotion Regulation, Flexibility,
Inhibitory Control, Initiation, Organization, Planning, Self-
Monitoring, and Working Memory.
 Empirical research on executive
function
Executive Function Among individuals With
Tourette’s Syndrome, ADHD, and ASD:
Self-regulation is a central prerequisite for adaptive
functioning and is commonly assessed via scales. EFs
scales have solid associations with neurobiological bases
of EF (Isquith, Roth, & Gioia, 2013) and are often employed
to assess clinical conditions associated with EF (Barkley,
2011). One of the most used EF assessment scales is the
Behavior Rating Inventory of Executive Function.
 Executive Functions and Learning Disabilities:
Children with learning disabilities often witness significant
problems in EFs (WM, inhibition of impulses, and shifting).
They often face difficulties in assessing, organizing,
prioritizing, and coordinating information in simultaneous
mental activities (e.g., reading, writing). They express poor
self-regulatory skills, lack effective strategies for problem
solving, and have limited thinking flexibility (e.g., Meltzer &
Krishnan, 2007; Hofmann, Schmeichel, & Baddeley, 2012;
Graham, Harris & McKeown, 2013). Moreover, students with
learning disabilities have difficulty with metacognitive skills,
and have inadequate planning and self-monitoring skills.
 Hawley and Newman (2010) suggest five stages for
teaching EF skills:
(1) engagement (i.e., attention and motivation), (2) awareness
of strengths and needs, (3) goal setting (i.e., identifying
realistic and measurable goals), (4) skill mastery, and (5)
generalization. Because EFs include cognitive processes that
coordinate, integrate, and control processes, strategies to
promote EFs generally address three main areas: self-
regulation (i.e., ability to monitor one’s own performance and
reflect on it), WM, and metacognition, all of which allow
students to engage in problem solving and goal-directed
behavior.
 Cognitive Training in Reducing Executive Function
Difficulties in Children With Intellectual Disabilities:

An increasing number of studies have explored the impact of

EF training in typically developing children, including those
within the general intellectual range of the typically
developing population, such as children with ADHD. These
studies have reported positive effects on early WM (e.g.,
Alloway, Bibile, & Lau, 2013 ) and emotional control skills (
Rueda, Rothbart, McCandliss, Saccomanno, & Posner, 2005).
THEORY OF MIND AND MINDBLINDNESS THEORY
The concept of ToM emerged in the 1970s when Premack and
Woodruff (1978) defined ToM as one’s ability to attribute mental
states to oneself and to others. ToM is defined as the ability to
infer and represent the intentions, beliefs, and desires of others.
ToM is also referred to as “commonsense psychology,” “naive
psychology,” “folk psychology,” “mind reading,” and “mentalizing.”
ToM provides information for the following functions:
(1) comprehend and explain (see a meaning in the behavior of
others), (2) predict (predict others’ behavior), and (3)
manipulate (influence and manipulate the behavior of others by
controlling the information available to them).
THEORY OF MIND AND MINDBLINDNESS THEORY
Hiatt and Trafton (2010) note that there are three competing
views for how ToM is expressed at a cognitive level. They are
typically described in the context of “belief and desire”
reasoning. ToM postulates that different people can have
different beliefs, not all of which may be actually true; people
can also have internal desires that influence their behaviors.
Thus, there is a distinction between “true beliefs” or beliefs that
are true in the physical world and “false beliefs,” which are not
actually true. Thus, the ability to understand a false-belief task
indicates that a person can appreciate the distinction between
the mind and the world (Wellman, Cross, & Watson, 2001).
THEORY OF MIND AND MINDBLINDNESS THEORY
Simulation theory (Gallese & Goldman, 1998). This view posits
that when a person (A) tries to understand another (B), A
simulates what he or she would do in B’s place and attributes
the result to B. Gallese and Goldman (1998) describe the
distinction between this and theory-theory as being that, while
theory-theory is performed as a “detached theoretical activity,”
simulation theory involves efforts to copy or impersonate the
mental state of another. A third perspective claims that the
mind has two separate mechanisms that collaborate to
provide ToM (Leslie, Friedman, & German, 2004). The theory of
mind mechanism (ToMM) allows people to generate and
represent multiple possible beliefs.
THEORY OF MIND AND MINDBLINDNESS THEORY
The “mindblindness” (MB) theory ( Baron-Cohen,
1995) proposed that in autism a “theory of mind,”
or cognitive empathy, is impaired to varying
degrees. The MB theory proposes that children
with ASD are still in the development of their ToM,
leaving them with degrees of MB. As a result, they
find others’ behavior confusing and unpredictable.
 The relationship between theory of mind and
relational frame theory
Impairments in social cognition and perspective-taking play an
important role in the psychopathology and social functioning of
individuals with social anxiety, autism, or schizophrenia-
spectrum disorders, among other clinical populations. More
recently, another approach to the study of perspective taking
has arisen through relational frame theory (RFT) (Hayes, Barnes-
Holmes, & Roche, 2001). As a contextual and behavioral account,
RFT postulates that perspective taking and other forms of
complex cognitive functioning can be examined by analyzing the
interactions between a person and his or her social environment.
In order to respond to questions, one must change from an “I-here-now” to
an “I-there-then” or “you-there-then” perspective. Thus, perspective taking
requires that people understandand respond to interpersonal (I-you), spatial
(here-there), and temporal (now-then) relations. Through repeated exposure
to these relations, specific “relational frames” emerge, enabling people to
generalize these relations to novel situations. In RFT terms, this generic
ability (there are other types of relational frames) is referred to as “derived
relational responding.” In order to examine the ability and flexibility to use
these perspective-taking relations, a protocol was developed by Barnes-
Holmes (2001), that assesses relational perspective taking at three levels of
complexity. A “simple” trial in theBarnes-Holmes protocol simply requires
participants to respond to an I-you, here-there, or now-then relation, for
example,

“I have a green brick and you have a red brick. Which brick do I have?”
 Developmental functions of ToM
The most famous empirical discovery in the developmental
framework of ToM is the discovery of a crucial cognitive
change in children between 3 and 4 years old whereby 3
year olds tend to fail a certain false-belief task. At the age
of 3, does not yet grasp the idea that a belief can be false.
In lacking a representational theory of belief, the child has
a “conceptual deficit” (Perner, 1991). It is believed that one’s
ToM is fully developed by around the age of 5, although
some studies suggest that flexibility in its use continues to
develop until late adolescence.
A number of theoretical perspectives have been proposed to
explain the developmental chart of ToM. For example, one
approach posits that the conceptual understanding of mental
states is present all along during the child’s development but that
the child lacks the sufficiently sophisticated general cognitive skills
that are required to solve ToM tasks (e.g., Leslie, 2005). This has
been conceptualized as a competence/performance distinction.
The second approach speculates that ToM competence develops
with age, which is referred to as the conceptual change
hypothesis (Perner, 1991; Wellman, 1990). Proponents of this view
have noted the shift around the age of 4 when children progress
from performance below chance to performance above chance
when reasoning about representational mental states, especially
false beliefs.
 ToM across the life span advancement
There is an increasing interest in how ToM is expressed in later life
span development. Two approaches have been advanced regarding
ToM’s developmental chart. The first approach suggests that declines
in ToM may be associated with declines in social functioning. A
cumulative body of evidence suggests that older adults show marked
reductions in aspects of fluid intelligence (e.g., Hedden & Gabrieli,
2004). Those aspects include skills, such as WM processing, speed,
and numerical ability. The second approach proposes that “a lifetime
accumulation of knowledge” about the social world may result in
more efficient social interactions. According to Hedden and Gabrieli
(2004) , older adults show preserving “crystallized” aspects of
intelligence, such as verbal memory, general knowledge, and
vocabulary.
The reciprocal relationship between executive functions
and theory of mind
EFs refer to a group of cognitive processes involved in flexible goal-
directed behavior. Given the diversity of these processes, there are
several ways that they can be linked to ToM. A variety of explanations
have been proposed concerning the associations between children’s
performance on false-belief tasks and measures of EFs (e.g., Leslie et
al., 2004). Emergence accounts suggest that EF is necessary for
children to learn abstract concepts by enabling disengagement from
the immediate objects of attention (e.g., Carlson & Moses, 2001).
Competence accounts argue that reasoning about false beliefs
requires WM capacity or other aspects of EFs to construct mental
representations with a certain degree of complexity (e.g., Andrews,
Halford, Bunch, Bowden, & Jones, 2003).
 The assessment of ToM

Questions about the nature, timing, and manner in

which ToM knowledge emerges have led to the
development ofvarious assessment measures ranging
from tasks to tap a child’s “developing understanding
of conceptions of desires, emotions, beliefs, belief-
desire reasoning, or psychological explanation,
among others” ( Wellman et al., 2001, p. 655)to
assessments of the production of mental state terms.
 The assessment of ToM
The simplest task that was developed in early ToM research was
the false-belief paradigm, which measures a person’s ability
to recognize the false beliefs of others (e.g.,Brüne & Brüne-
Cohrs, 2006). The two most common measures that employ this
paradigm are the Sally–Anne test and the Smarties test. The
Sally–Anne test (Wimmer & Perner, 1983) is used for assessing
the capacity of “meta representation” (the subject is required to
predict a character’s behavior using information integrated in a
story). The Smarties test (Perner, Frith, Leslie, & Leekam, 1989 )
assesses the child’s capacity to notice an individual’s false
belief.
Wellman and Liu (2004) devised a developmental scale of ToM that
assesses multiple milestones in the evolution of social cognition or ToM
conception:
Diverse Desires (DD): Child judges that two persons have different
beliefs about the same object.
Diverse Beliefs (DB): Different people have contrasting, potentially
true, beliefs about the same thing.
Knowledge Access (KA): Child sees what’s in a box and judges
(yes/no) the knowledge of another person who does notsee what is in
the box).
Contents False Belief (FB): Child judges another person’s false belief
about what is in a distinctive container when child already knows what
is in the container.
Hidden Emotion (HE): Child judges that a person can feel one thing but
express a different emot
 ToM Comprehensive Measures
ToM comprehensive instruments are composed of multiple
tasks. The total score of such a test is a compound score.
Research on ToM has shown compound scores to be more
stable and to offer a more accurate measurement of the
underlying skill ( Hughes et al., 2000). In addition, to
providing a single, quantitative measure of the level of
ToM ability, the compound score also allows the
comparison of different relevant ToM components in the
same child and their trajectory during the course of
development.
 Examples of comprehensive ToM tests
The ToM battery of Happé (1994) incorporates first-
order belief tasks, first-order deception tasks, second-
order belief tasks, and second order deception tasks.
The ToM tasks of Tager-Flusberg (2003) consist of
three batteries tapping early (pretend and
desire),middle (perception/knowledge, location-change
false beliefs, unexpected-contents false beliefs, and
sticker hiding) andmore advanced ToM aspects
(second-order belief, lies and jokes, traits, and moral
commitment).
The ToM Test (Steerne-man et al., 2002; Muris et al.,
1999) consists of three subscales tapping ToM precursors
(e.g., recognition of emotions and pretense), first
manifestations of a real ToM (e.g., first-order belief and
false beliefs), and more advanced ToM aspects (e.g.,
second-order belief and humor).
The ToM tasks of Wellman and Liu (2004), comprises
simple ToM tasks only. The tasks tap various desires,
diverse beliefs, knowledge access, content false
beliefs, explicit false beliefs, belief emotion, and real-
apparent emotion.