allel TB] A) rD] rS] EEC ee Cee a Rit cm PAX Crete ROLLS Som Cl Beene ManualHj 0000 GE Behavioural Assessment Thames Valley TestCompany Of the Dysexecutive Syndrome Barbara A Wilson, Nick Alderman, Paul W Burgess, Hazel Emslie, Jonathan J Evans Bury St Edmunds, England, 1996 Thames Valley Test CompanyBehavioural Assessment of the Dysexecutive Syndrome Allrights reserved Copyright © 1996, The authors “This test may not be reproduced, in whole or in partin any form (except by reviewers for the public press) without ‘written permission from the publishers Published by “Thames Valley Test Company 7-9The Green Flempton Bary St Edmunds Suffolk 28st. England Designed by Andrew Boag “Typographic problem solving Primed by Herald Graphics 19 Beckton Road Reading SESH2 2 2 12 12 2 13 3B Contents 1 Introduction 1.1 Problems with existing tests Description of the tests 2.1 Rule Shift Cards Test (Wikon, Alderman, Burgess, Enslie & Feans) 2.2 Action Program Test (Adapted from a test originally described by Klosowske, 1976) 23 Key Search Test (Influenced bya test originally described by Terman & Merril, 1937) 24 Temporal Judgement Test (Alderman, Evans, Enutie, Wilson & Burgess) 2.5 Zoo Map Test (Alderman, Evans, Emslie, Wilson © Burges) 2.6 Modified Six Elements Test (Burgess, Alderman, Esans, Wilson, Emslie & Shalice) “The Dysexecutive Questionnaire (DEX) (Burgess, Alderman, Wilson, Evans & Emslic) 3 Collecting performance norms 3.1 Control Subjects 3.2 Patients 4 Instructions for administering the tests 4.1 Rule Shift Cards Test 4.2 Action Program Test 4.3 Key Search Test 44. Temporal Judgement Test 4.5 Zoo Map Test 4.6 Modified Six Elements Test 4.7 The DEX Questionnaire 5 Scoring the BADS tests 5.1 Rule Shift Cards Test 5.2 Action Program Test 5.3 Key Search Test 5.4 ‘Temporal Judgement Test 5.5 Zoo Map Test 5.6 Modified Six Elements Test 5.7 The DEX Questionnaire .$ Obtaining the BADS profile score 6 Reliability 61 Inter-rater reliability 62 Test-retest reliability 15 16 16 7 18 20 20 20 2 2B 7 Interpretation of scores and validity of the BADS 7.1 Interpretation of the scores 7.2. Comparison of performance on BADS tests between control and patient groups. 7.3 Effects of age 74 Ratings of executive functioning difficulties made by patients and significant others on the DEX 7.5 Validity of the battery: relationship between performance on the BADS and ratings of executive problems. 8 Summary 9 Appendices 9.1 Appendix 1: Scoring the Key Search Test 9.2. Appendix 2: Sample scoring of the Key Search Test 9,3, Appendix 3: Scoring the Zoo Map Test References Acknowledgements We would like ro thank Dennis Chiapello (Phoenix), Susie Chase (Pittsburgh), Hazel Dusoir and Paul Richardson (Belfast) for testing some of the patients for this study, and Sheila McCree, manager of Workshop 6 in Sheffield, for providing access toa significant number of normal controls and facilities for testing them. ‘We would also like to thank John Hodges (Cambridge) for help in the development ofthe battery and in partic- ular for referring many of his patients forthe validation study: We are grateful to Jim Mack, Jil Weingardner (Cleveland), Arna Ronen and Jenny Yiend (Cambridge), for their help inthe development ofthe Key Search task, and Danuta Klosowska for permission to adapt her action plan test. A special thanks goes to Julia Darling forall her help with the preparation of materials, ‘We would like to acknowledge St Andrews Hospital, Northampton, for supporting Nick Alderman's research “The development ofthis test battery was funded in part by agrant from the East Anglian Regional Health Authority (Locally Organised Research Scheme),ll Behavioural Assessment of the Dysexecutive Syndrome Introdu “The Behavioural Assessment ofthe Dysexecutive Syndrome (BADS) isa test battery aimed at predicting everyday problems arising from the Dysexecutive Syndrome (DES). The DES closely resembles what was once called the frontal lobe syndrome’, term that‘is used to refer toan amorphous, varied group of deficits resulting from diverse aetiologies, different locations, and variable extents of abnormalities’ (Stuss and Benson, 1984, p.3) Baddeley and Wilson (1988) argue that specification of, aasyndrome in terms of localisation is unfortunate and potentially misleading. We do not classify memory, lan- fuage, reading or perceptual deficits in this way as it ‘would be inadequate and limit our understanding of the observed cognitive phenomena. Similarly, a functional definition seems more appropriate tothe deficits arising from frontal lobe damage. “Although there is great variability in the extentand degree of impsirment.in patients with frontal lobe dam- age, certain features are highly characteristic. Rylander (1939) described them as ‘disturbed attention, increased arabe reperses 17 Keomtedge sparse Sesocston 18 Deracabiity 1 Loss of deco making abity 20 Uncancer for socal res 31 ne Collecting performance norms 7 likely changes: emotional or personality changes, motiva- tional changes, behavioural changes, and cognitive changes. Items include statements such as: ‘Tact without thinking, doing the first thing that comes tomind’; ‘have difficulty thinking ahead and planning for the future’;and ‘I find it difficult to keep my mind on something and am easily distracted’. Each item is scored on 2 5-point (0-4) Likert scale (ranging from ‘Never’ to ‘Very often’). The individual characteristics of the Dysexecutive Syndrome, ‘which these questions aim to investigate, are shown in “Table I. The DEX Questionnaire comes in two versions, ‘onc of which is designed to be completed by the subject and another by a relative or carer who has close, prefer~ ably daily contact with them, Collecting performance norms Control Subjects We tested a stratified sample of 216 subjects comprising approximately equal numbers of subjects in each of three ability bands, ‘below average’, average’ and ‘above aver~ age’ (determined by the National Adult Reading Test 1Q ‘equivalent scores of 89 and below, 90-109 and 110 and above respectively), and balanced so as to have approxi~ ‘mately equal numbers of men and women in each ofthese bands from each of the four age groups 16-31, 32-47, 48-63 and 64+. As in previous studies involving the col- lection of population norms (Baddeley, Emslie & Nimmo- ‘Smith, 1992, 1994) we chose to have approximately equal ‘numbers of subjects in each category in order to ensure that no one group, defined either by age or by ability, was over or under-represented. As has been noted elsewhere (Baddeley, Emslie & Nimmo-Smith, 1993, 1994) recruit- ing a balanced sample is far from easy given a general reluctance on the part of many people from the lower socio-economic groups to participate in anything involv- ing tests of language or problem solving. There is always ‘adanger that under these circumstances the people who volunteer to be tested are a-typical. We went to great lengths to avoid any volunteer bias by adopting the follow- ing recruitment strategy: First we contacted subjects who hhad participated in the previous collection of population norms (Baddeley etal., 1993, 1994) since their age, years ‘of education, occupation and NART scores were alveady known. We were able to contact about 130 of these but ‘many of the younger subjects, especially those who had been unemployed when last tested, proved impossible to locate. We then balanced the numbers in each of the 12 ‘groups by selecting additional subjects purely on the grounds of age, gender and occupation. The few ‘above average’ subjects that were needed were recruited from the staff of St Andrew’s Hospital Northampton. The “below average’ subjects were more difficult ro recruit. We ‘were fortunate enough to be able to tap into an organisa tion ina large northern town, which provided work expe rience/ training for adults who had been unemployed for32 4d ‘Behavioural Assessment of the Dysexecutive Syndrome more than 6 months, and young people with a history of learning difficulties and/or social problems but who had never been impaired enough ro need to be educated in = special school. We were thus able to recruit as many of the average and below average subjects.as we needed to ‘balance the numbers. “Tinus the complete battery was administered to the 216 neurologically healthy control subjects aged between 16and 87 years (mean age = 46.6, SD = 19.8). Mean NART FSIQwas 102.7 (SD = 16.2, range 69-129). Patients [Ninety-two patients, who presented with a variety of nea rological disorders, were tested on the battery and 2 range of other neuropsychological measures, These included the WAIS-R (Wechsler, 1981), Cognitive Ertimates Test (Ghallice & Evans, 1978), and a shortened version of the Wisconsin Card Sorting Test Nelson, 1976). The bulk of the sample were individuals with closed head injury (52 per cent), Most other patients had acquired brain damaze asa result of encephalitis (6.5%), dementia (13%) or seroke (8.5%), Twelve patients (13%) had acquired brain damage asa result of other means (for exemple, senshot ‘wound [1}, anoxia [4] and Korsakoff’s Syndrome [1 ‘A total of78 patients completed all six tests of he BADS battery. Consequently, only these were selected for analysis in the validation study. These were see ‘between 19 and 76 years (mean = 38.8, SD = 15.7) with amedian NART FSIQof 103.2 (SD = 13.2, range 73-136). Mean WAIS-R FSIQ for the patients was 92.8 (SD = 15.7, range 53-136). Patients were recruited from anumber of centres including the MRC Applied Paychology Unit and Addenbrooke's Hospital in Cam- bridge; the Kemsley Division (a brain injury rehabilita- tion service) of St Andrew’s Hospital in Northampton University College London; The Royal Victoria Hospital Belfast; the Adult Day Hospital for Neurological Rehabil- itation, St Joseph's Hospital, Phoenix; and Behavioral Neuropsychology Associates, Pittsburgh. "There was no significant difference between the nor- ‘mal controls and the patients on performance on the NART (t= 0.28, p = 0.782). However, the mean age of ‘the normal control group (46.6) was higher than that of the patients (38.8) (t= 3.46, p = 0.001). Instructions for administering the tests Rule Shift Cards Test ‘You will need the Rule Shift Cards booklet, rule cards and stopwatch, Put playing card booklet, unopened, the subject and have the rule sheet ready. ‘Thisis a booklet of playing cards, Iam going to turn over theve playing cards one ata time and after each one I want “you ta say "Yes' or ‘No" according to a rale which you will “have infront of you. You should try to respond as quickly between you and Instructions as you cam and a accurately as you can. Here isthe fist vale Place Rule 1, ‘Say Yes to Red, No to Black’, in front of the subject, slightly to one side, and read italoud. Then ‘administer the first trial. Please note for Rule 1 start with the second card, ic. the two of diamonds. Time the tial sand note the subjects’ responses. Then say Tam going to turn over the set of cards again now, and ‘again you wil be saying either Yes'or ‘No’ to cach one as (quickly and as accurately as you can but this time there isa Afferent rule Turn over the rule card to show Rule 2, and say This time... end scad out the rule to the subject. Then say So we ill leven haze one card shoring already and turn to the first cand i the four of hearts. Administer the second trial ‘noting responses and time. Action Program Test ‘You wal need the materials as shown in the diagram ‘below, some watex, paper towels and 2 stopwatch, (Outef sight of the subject fill the beaker two-thirds full of watex and replace the id. Place the equipmentin front of the subjects follows Container |Wirehook (Base screw top Container Tube and cork Beaker and id ‘Subject sits her facing the equipment ‘Then say ‘T you lookin the bottom of this tube you will sce a small cork, Your task isto get the cork out of the tube. You can tue any of these things (indicate equipment) 10 help you. ‘However you must not lift this up (indicate main assem- ‘ly), nor this indicate beaker) nor this (indicate the tall tube) and you cannot touch this (indicate lid) ith your “fingers. Now go ahead and try to get the cork out ofthe tube. after 2 minutes, the subjectis clearly unable to progress, assist as follows: "give you some help, then ‘remove the lid withthe wire hook, and say Try and com- plete the task nom. Tfaftera further 2 minutes has passed the subject still cannot proceed to the next stage give a further prompt by demonstrating what needs to be done, eg. attaching the screw top to the container. If necessary continue prompt ing inthis way until the cork has been retrieved. ‘Tick/check each stage that the subject completes independently.43 Behavioural Assessment of the Dysexecutive Syndrome Key Search Test ‘You will need a copy of the response sheet, a penanda stopwatch. Place the response sheet in front ofthe subject with the place for the subject’s name at the top right. Takea pen (to prevent erasures) and hold it while saying Trant you to imagine that this square (with the pen trace in the air the sides of the square) isa large field. Some- ‘herein this field you have lost your keys. You don’t know ‘exactly where you have lst them because you have been all over the field, all you know is that they are somewhere inthe field. Pause to make sure the subjectis grasping the instruc- tions, then touch the dot below the square with the pen andsay ‘Starting from this dot I want you to draw a line with the ‘ben to show me where you would walk to search the field t0 make absolutely certain that you would find your keys no matter where they were Ifthe subject seems not to grasp that the line made with pen isto demonstrate where they would walk, eta piece of paper and —_well away from the square — draw a circle and say ‘Ifyou drew this it would show that you had started here ivalked round ina circle and ended up where youstarted. Ifyou drew a line like this (draw an L shape) it would shoe me that you walked down ther, turned leftand walked along there Although I willbe timing you, theres no time limit, Take 1s long as you like to search the field but make sure you search t carefully s0 that you are certain to find the keys tno matter where they are. Take the pen and starting from the dot (point) dras a line to show where you are walking to search the field. Start the stopwatch as soon as you have given the instruc- tion above and note total time on task. ‘Should the subject lift the pen so the line is not contin- ‘uous, whenever this might be, say ‘Remember to keep the pen on the paper so that I ill be able to tell here you have been walking If necessary these instructions may be repeated or re- ‘worded at this time to help the subject grasp the mezning ‘but once the subject appears to understand, or if you decide the subject is incapable of grasping the point, do mot repest the imstraction. For subjects who draw in the air rather than making line on the page the instruction to keep the pen on the ‘paper may be repeated as many times as necessary. While the subjectis drawing make notes so that you can, ifnecessary, reconstruct the sequential order in which the lines were drawn. ‘If subjects ask questions, respond in the manner indi- ‘ated above, taking care not to give any information which can be used to direct the search in a particular way. 44 45 Instructions 8 When to stop ‘The following instructions should be given ifa subject attempts to halt the search prematurely (asin a-c below), but they should be given only once (a) Ifa subject asks when s/he can stop searching say Keep searching until you are certain you will find the keys. (b) Ifthe subject indicates that he or she is only going to search that part of the field where they had been earlier say You don't know in whick part ofthe field your keys are ‘because you have been all over the field, you only know that they ae in there somewhere, s0 keep searching until “you are sure to find them no matter where they are. (c) If the tester is unsure whether the subject has finished searching say Have you finished your earch? the answer is yes or the subject says the keys have been found, stop the test. Ifthe subject says no say Remember to search the hole field. Timing Hale the stopwatch when the subject finally stops search ing. Don’estop the watch for interruptions ike a-c above, ‘The only occasion on which timing should be halted and restarted is if you have to explain toa subject about keep- ing the pen on the paper if that explanation occurred before the subject actually started to search the field. All other explanations will be included as part ofthe total time. ‘Temporal Judgement Test am going to ask you 10 estimate how long it takes to do four things. Isay estimate because I don’t expect anyone to know the exact ansivers to these questions. Tam not ask- ing if you know the answer, I am asking you to estimate, that is, make a sensible guess [Askeach question, encouraging the subject to ‘just make a sensible guess’ if they say they don’t know. ‘Zoo Map Test ‘You will need copies ofthe response sheets for Versions 1 & 2, a stopwatch and coloured pens. Version 1 Place a copy of the 200 map and rules for Version 1 in front of the subject, say: Here isa map of a zoo. Your task sto plan a route around the 200 to visit al the places listed in the instructions (indicate), You willbe draming a line to show me hor you are planning to go from one place to another and I ill give you adifferent coloured pen after you have visited cach place. [t's not part ofthe test, it simply reminds me of the order that you visited the places when I look atthe map later. Now read aloud the instructions Allow the subject to read the instructions. Ifthe subject,10 Behavioural Assessment of the Dysexecutive Syndrome has difficulty reading them fluently do so yourself or read them with the subject. When the instructions have been read (by the subject or tester) clarify the rules by reading them again and pointing to the relevant locations 2s, follows ‘So you must start at the entrance (point to Entrance) and Jinsh with apiene (point to Picnic are). You may we the shaded paths like these (point tothe shaded path atthe entrance, Bears, Monkeys and Bird Sanctuary) as many times as you lke, but the unshaded ‘ones (point tothe path leading to the Elephants, along to the Reptiles and up to the Picnic area) only once Youmay take only one camel ride, This means that ifyou suse any part ofthis camel-rides path indicate camel ride section, which includes lines either side) later on you cannot use any other part oft ‘Some subjects ask whether they may mark items on the list of rules when they have visited places, or mark on the ‘map the places they intend to visit. Both are allowed, but should not be suggested to subjects in advance Having clarified any queries about the task, say While [will use this stopwatch o see how long it takes you todo the task, the time really is not important — the mast important ching isto visit all the places listed sm the instructions, without breaking the rules. Sa, start when syow are ready. Begin timing immediately and record the planning time (Gime until the subject begins to draw the route with the pens) and the total time (planning time plus time to draw route), Remember to change the colour ofthe pen used after the subject visits each place and record the order of the colours on the scoring shect as each pen is handed back. Iie also helpful to write on the scoring sheet the order of the locations visited as the subjects completing the test. This facilitates scoring. Ifthe subject realises an error has been made and cannot visit all the places with- out going over an unshaded route already used, encourage the subject to continue by saying Ifyou have o use the unshaded paths that you have already used in order to vist all the places left, please do s0 «asthe most important thing to dois to visit all the places on the lit. Version 2 Remove map and rules for Version 1; replace with a copy ‘of the 200 map and the instructions for Version 2. Say, The next day you go back to the 200 for another visit but this time the instructions have changed. Could you jst read aloud this second st of instructions please? (Clarify instructions and record timings asin Version 1 46 Modified Six Elements Test ‘You will need 2 tape recorder, stopwatch, pencil, eraser, spare paper and test materials as illustrated below. Instructions Arrange the test materials (tape recorder, two sets of arithmetic problems, two sets of pictures, a timer and the sheet of instructions) plus 2 few sheets of paper, a pencil and an eraser in front of the subject in the following way: Picores [Pictures A \8 AhoA 1 1 Mi | Paper Eraser! ‘You gt tem minutes for thie mext test and in this test you pill be dong three different kinds of tasks (indicate equipment) The fist task involves describing events (point to number I on the instruction sheet). The second (point to number 2 on the instruction sheet) incolves writing down on the paper I’ve given you, the names of some pictures shown on these cards. The third (point to number 3on the instruction sheet) votes solving some simple arithmetic problems on these cards here, again writing the answers down on the paper I’ve given you Each ofthese three tasks is divided into to parts, Part A ‘and Part B. There are two sts of arithmetic problems (poine to the relevant part ofthe instruction sheet), 20 sets of pictures (point) and to dictation exercises (point) Go through each task with the subject with reference to the shect of test instructions, making sure that you remind the subject that they do not have to do the ealcula- tions by mental arithmeticif they do not wish to, and can use the paper to do the calculations. During the next ten minutes I would lke you to try to complete at least some ofeach ofthe six individual parts There is no way that you willbe able to complete every- ‘thing in just ten minutes, The mast important thing then, isnot to try to complete any one task, but make sure you ‘have ago at completing at least some ofall six parts. However, there is ome rule that you must obey: you cannot ‘move on tothe second part ofa task immediately after you shave attempted the fist part ofthe same task, and ofcc 87 Behavioural Assessment of the Dysexecutive Syndrome ‘The DEX Questionnaire ‘The DEX is not formally part of the BADS in the sense that itis not used in the calculation of the profile score for the battery (see section 5.8), Individual item scores may be totalled in order to allow a broad comparison of the ratings of relatives and patients. Clinical use of DEX ratings is discussed in section 7.1 Obtaining the BADS profile score An overall profile scare for the whole battery is obtained bby adding together the individual profile scores for each test. Any subject who completes the whole battery will therefore obtain a BADS profile score within the range of 010.24, 62 Reliability 3 ‘Across the six tests, 18 items are scored. As can be seen in Table 2, inter-rater reliability is high, ranging between (0,88 to 1.00, Absolute agreement was obtained on 8/18 items, The lowest correlation was obtained on recording the maximum time completing one task on the Modified Six Elements Test (0.88). Despite the apparent complex- ity of the scoring system for the Key Search Test, there ‘was an impressive correlation of 0.99 between raters on this measure. All remaining correlations were within the 0,90 to 0.99 range. We are therefore confident that the initial scoring system, which provides the information from which the profile scores may be extracted, is easy to implementand highly reliable Test-retest reliability Given that one of the critical aspects of tests for assessing the Dysexecutive Syndrome is novelty, one would not 6 Reliability necessarily expect that test-retest elabilty would be ‘ery highs the testsare not nove when administered for 6.1 Inter-rater reliability asccond time. However, since it would be desirable in “Twenty five ofthe normal control subjects were tested eee cat aiemta write second It: Pre oe ng, __ BADS,weretested 29 of the normal contol subjects on the necessary a5 cs ofthe Key S : +h Test, ‘Modified the battery 6-12 months after completing it for the first SixElementsTetand Zoo Map Test were scored inde- _te. Thesame group ofabieas dso complied te Six Bement Textand Zoo Ma Tee verre, fegucly administered frontal lobe ests on beh he ensure consistency in the scoring of the Key Search Test, pocasians ag rat test-retest Phenomena observed on the BADS could be contrasted with performance on these sn Occupational Therapist on the Applied Psychology ee ‘Unit Subject Panel re-scored all drawings made by the — m = entire contol nd patent groups Theresultsareshown in Table 2. Table2 interrater reliability Correlation Test tem sored betwoenraters. Significance ‘cion rogram Number tasks passed independent 1.00 p< 0.01 Key Search* ‘Score out of 16 0.99 p<0.001 Time to complete 0.99 p<0.001 ModiedSixsements Nunberofubtastsatempted 1.00 p<0.001 i Number fru breaks 100 p< 0.01 Maximum time on one task oss p alate tet mteenemenenneme apna nets 20 Behavioural Assessment of the Dysexecutive Syndrome 8 Summary We have reported and described the BADS, a new test to assess everyday problems arising from the DES. In the development of the BADS we have been influenced by two theoretical models. The first isthe working memory ‘model (Baddeley 8: Hitch, 1974) with its hypothetical ‘construct of a central executive (CE). This CE can be ‘conceived as an overall controller, organiser, planner and allocator of resources. Baddeley, Logie, Bressi, Della Sala snd Spinnler (1986) and Hartman, Wilson and Pickering (1992) suggest that the CE is defective in patients with ‘Alzheimer’s disease and severe traumatic brain injury. “The second model influencing the development of the BADS is the Attentional Control System proposed by Shallice (1982). This model comprises two attentional mechanisms—2 contention scheduling system respon- sible for the more routine aspects of attention, and a supervisory atentional system which is responsible for higher level, more demanding attentional tasks. Patients with the DES may have few problems with tasks involving the contention scheduling system, but typically have great difficulty with tasks involving supervisory attentional systems, ‘We have also been influenced by the development of ccologically valid assessment tools that map onto real-life ‘behaviours. Forerunners of the BADS include The River- mead Behavioural Memory Test (Wilson, Cockburn & Baddeley, 1985); the Communicative Abilities in Daily Living (Holland, 1980); the Behavioural Inattention Test (Wilson, Cockburn & Halligan, 1989) and the Test of Everyday Attention (Robertson, Ward, Ridgeway & Nimmo-Smith, 1994). ‘The BADS should prove useful to clinical psycholo- gists, ncuropsychologists and other therapists involved in the assessment of people with brain injury It will assist them in identifying whether or nota patient has executive deficits likely to interfere with everyday life, and it will help them determine whether their clients have a general impairment of executive functioning ora specific kind of ‘executive disorder. The BADS would also appear to be useful for the assessment of executive functioning in schizophrenia, asa small study (Evans, McKenna, Chua & Wilson, submitted) suggests that people with schizo- phrenia perform very similarly to people with brain injury. Finally, the BADS might prove to be useful in neuro- psychological and psychiatric rehabilitation. Because the BADS provides tool for picking up subtle difficulties in planning and organisation, particularly in those people who appear to be cognitively well preserved and function- ing well in structured situations, it might prove tobe par- ticularly useful in assessing and preparing patients for ‘moves from hospital care into more independent living situations. We look forward to further research using the BADS for planning and evaluating rehabilitation. 91 Summary & Appendices Appendices Appendix 1: Scoring the Key Search Test 1 Entering the field Entering ateither of the bottom corners is the most effi- cient strategy, so entering within 10 mm of cither bottom corner gains 3 marks. Entering at any other point along. the base gains 2 marks. Entering anywhere else scores 1. 2 Finishing the search ‘The instructions do not specify thata subject has to leave the field. Finishing within 10 mm of any corner (as in 4a, 4b, 4d and 4c below) gains 3 marks, finishing anywhere ‘else along the base (asin 4c and 6i.e) scores 2 and finishing anywhere else (asin Sa, 5c, 6 j and biti d) scores 1. 3 Continuous line ‘This mark should be awarded even ifa subject has lifted the pen off the paper as long.as s/he has either replaced the pen at the same point or joined the line upas when parallel lines are drawn left to right across the square and the ends are then joined vertically asin 3a below. The mark is not awarded when 2 subject takes the pen off the paper and replaces it at a different pointas in 3b or 3c but {2 given if the lines go to the field edgesas in 3d where the ‘subject clearly has the solution. 3 3 x x ae iaey Bes 0 0 1 Score: 1 4 Parallel [fall the lines have the same basic orientation this would ‘be awarded the mark regardless ofthe shape of the line ‘ends’ thus the first four drawings below score 1, the fifth 0. Ifa line at right angles to the basic pattern is simply a means of getting to the nearest corner asin 4c or exiting at the point of entry as in 4a, the markis still awarded aa° 1Appendices 22 Behavioural Assessment of the Dysexecutive Syndrome 9.2. Appendix 2: Sample scoring of the Key Search Test enter finish continuous, parallel vert/horiz patterns, all ground find keys Total enter finish continuous parallel vert/horiz patterns all ground find keys Total 2 i 1 0 0 0 1 0 593 Behawigural Aasessment of the Dysexecative Syndrome Aopen Pisce the semplstc over the map and check each of the scctsons of unshaded paths Inbelled A~M to see ifany Seve been used more than once. One error point isawarded Ger cack occasion that this happens, for example ifa path is three times two error points are awarded. Thus there Scoring the Zoo Map Test 7 ‘would be five error points in the example below, one for section H, one for section I, one for section K and two for section C (NB crossing from Elephants to Crocodiles counts as one Camel ride). (One error point is awarded for deviations from the path. ‘This happens once in the example (en route to the Bears). One error point is awarded for each failure to make 2 con- tinuous line. This is only awarded when the subject jumps from one place to another. In the example, the subject's first visit is to the Llamas but s/he then jumps to the Elephants. This would merit one error point. S/he would not be penalised for the break in the lineat, for example, the Bears, Tigers or Bird sanctuary. ‘On the scoring sheet put across beside each inappropriate place visited. There are three in the example. ‘There are four possible correct sequences, namely First Second Third Fourth Fifth Entrance Llamas Elephants Cafe Bears Entrance lamas Cafe Elephants Bears Entrance Elephants Cafe lamas Bears Entrance Cafe Elephants Uamas Bears Sixth Lions Lions ons ons Seventh Bird sanctuary Bird sanctuary Bird sanctuary Bird sanctuary “To gain a sequence point the place mast be at the correct ‘number in the sequence, thus, for example, the Bears only score a point if they are the fifth place visited whereas the Elephants will score point 2s long as they are either sec cond, third or fourth. In the example, the sequence Senre is, Note that although the subject finished with the Bird sanctuary and Picnic area these were not awarded poms as they were not the seventh and eighth places visited Subject’s sequence First Entrance v Second amas v Third Elephamts Fourh Crocodiles =X ith Tigers x Sixth Small Mammals X Seventh Cafe Eighth Bears Lions Bird sanctuary Picnic area Sequence score 3 Appendices Note also, if'asubject takes the route~ Entrance, Bears, Lions, Cafe, Llamas, Elephants, Bird sanctuary, Picnic— going from I ions to Cafe via paths K and Cand from Elephants to Bird sanctuary via paths Band C— this ‘would count as two camel rides, even though the lines vwill not overlap, and would thus incur one error point. Eighth Picnicarea Picnicarea Picnic area Picnic area(2 Behawinursi Assesument of the Dysexecstive Syndrome References Alderman, N., & Ward, A. (1991) ‘Behavioural treatment ‘of the dysexecutive syndrome: Reduction of repetitive speech using response cost and cognitive overlearn- ing.” Neuropsychological Rehabilitation, 1, 65-80 Baddeley, A. D. (1986) Working memory, Oxford: Claren- don Press Baddeley, A. D., & Hitch, G. (1974) ‘Working memory’ in G. H. Bower (Ed.), The psychology oflearning and ‘motivation, Vol. 8 (pp. 47-89), New York: Academic Press Baddeley, A. D., Emslie,H., & Nimmo-Smith, I. (1992) The Speed and Capacity of Language Processing (SCOLP) Test, Bury St Edmunds, Suffolk: Thames Valley Test Company Baddeley, A. D., Emslie, H., & Nimmo-Smith, I (1993) “The Spot-the-Word Test: a robust estimate of verbal intelligence based on lexical decision.” British Journal of Clinical Psychology, 32, 55-65 Baddeley, A. D., Emslie, H., & Nimmo-Smith, I. (1994) Doorsand People: A test of visual and verbal recall and recognition, Flempton, Bury St. Edmunds: Thames ‘Valley Test Company Baddeley, A. D,,& Wilson, B. A. (1988) Frontal amnesia and the dysexecutive syndrome’, Brain and Cognition, 7, 212-230 Baddeley, A. D,, Logie, R., Bressi,S., Della Sala, S., 8 Spinnler, H. (1986) ‘Dementia and working memory’, Quarterly Journal of Experimental Peychology, 38, 603-618, Benton, A., & Hamsher, K. (1989) Multilingual Aphasia Examination, lowa City: A.J.A. Associates Burgess, P. W.,& Alderman, N, (1990) ‘Rehabilitation of dyscontrol syndromes following frontal lobe damage: A cognitive neuropsychological approach’, in R. Ll. Wood & I Fussey (eds), Cognitive rehabilitation in perspective (pp. 183-203), Basingstoke: Taylor and Francis Led. ‘Burgess, P. W. (in press) “Theory and methodology in ‘executive function research’ in P. Rabbitt (ed) Method ology of Frontal and Executive Functions, Hove: LEA de Wall, C,, Wilson, B. A. & Baddeley, A. D. (1994) “The Extended Rivermead Behavioural Memory Test: ‘A measure of everyday performance in normal adults’ Memory, 2, 149-166 Dunker, K. (1945) ‘On problem solving” Poycholegical Monographs 58.5, Whole No. 270 Eslinger, PJ, & Damasio, A.R. (1985) ‘Severe distur- bance of higher cognition after bilateral frontal lobe ablation: Patient EVR’, Neurology, Cleveland, 35, 1731-1741 Evans, J. J, Chua, SE, McKenna, P.J., & Wilson ,B. A. (1995) ‘Assessment of the dysexecutive syndrome in schizophrenia’, Manuscript submitted Harman, A., Wilson, B. A.,&Pickering, R-M. (1992) ‘Is there a central executive deficit after severe head injury? Clinical Rehabilitation, 7,43-50 Holland, A... (1980) Communicative abilities in daily living, Baltimore, MD: University Park Press | Klosowska, D. (1976) ‘Relation between ability to pro- gram actions and location of brain damage’. Polish Paychological Bulletin, 7 (4), 245-255 Nelson, H. E. (1976) ‘A modified card sorting test sensitive to frontal lobe defects’, Cortex, 12, 313-324 Robertson, I. H., Ward, T, Ridgeway, V,, & Nimmo- ‘Smith, I. (1994) The Test of Everyday Attention, Bury ‘StEdmunds, Suffolk: Thames Valley Test Company Rylander, G. (1939). ‘Personality changes after operation on the frontal lobes’, Acta Prychiatrica Newrologica, Supplement No. 30 Sazbon, L. & Groswasser, Z. (1991) ‘Editorial. Prolonged ‘coma, vegetative state, posteomatose unawareness — semantics and better understanding’, Brain Injury, 5, 38 Shallice, T (1982) Specific impairments of planning’, Philosophical Transactions ofthe Royal Society London B, 298, 199-209 Shallice, T, & Burgess, P. (1991) ‘Deficits in strategy application following frontal lobe damage in man’, Brain, 114, 727-741 Shallice, T, & Evans, M.E. (1978) ‘The involvement of the frontal lobes in cognitive estimation’, Cortex, 14, 294-303, Stuss, D. T, & Benson, D. F (1984) ‘Neuropsychological studies of the frontal lobes’, Prycholegical Bulletin, 95, 1,3-28 ‘Stuss, D. T,,& Benson, D. F. (1986) The frontal lobes, New York: Raven Press ‘Terman, L.M., 8 Merril, M. A. (1937) Measuring intelligence, Boston: Houghton Mifflin Wechsler, D (1981) Manual for the Wechsler Adult ‘Inselligence Scale — Revised, New York: The Psycholog- ical Corporation Wilkon, B. A., Cockburn, J, Baddeley, A. D. (1985) The Rivermead Behavioural Memory Test, Bury St. Edmunds: Thames Valley Test Company Wilson, B. A., Cockburn, J., & Halligan, P. W. (1989) The Behavioural Inattention Tes, Bury St Edmunds: ‘Thames Valley Test Company Wood, R. L. (1988) ‘Management of behaviour disorders ina day treatment setting’, Journal of Head Trauma Rehabilitation, 3, 53-62