Luís Pires

lpires@fpce.uc.pt
The EF’s main function is
to facilitate the adaptation
to new or more complex
contexts/situations (Collette et
al., 2006).

There are different

functions considered to be
executive and even
different subprocesses
underlying each EF are
interrelated (Burgess & Shallice,
1994; Miake et al., 2000; Friedman &
Miake, 2004).
 The execution of goal-directed
behaviour allows understanding
the EF as essential for:
1. Establish plans – “control
trees” (goals, sub-goals,
sub-sub-goals)
2. Coordinated execution of
the plans – adjustment of
the mobilization of the
different processes,
necessary to achieve the
presented sub-goal until the
top objective is reached
Note: EF cease to act when
sub-goals are incorporated in
automated routines.
EF DEVELOPMENT
Even at 20 years of
age, we can see
some green dots in
the prefrontal cortex
area indicating that
EF would not yet be
fully developed.
(Diamond, 2016)

There are authors

who indicate the age
of 25 as the age from
which EF would be
fully developed
(Barkley, 2011)
EF development
During EF development there are changes in the way control of our
behaviour is carried out:

1. From an external representation of goal-directed behaviour to an

internal representation, regulated at the level of thought.

2. From a regulation of goal-driven behaviour in accord with others

(e.g., parents, teachers, friends) to self-regulation.

3. From regulation for the present to regulation taking into account

what we will have to do in the future, increasing our time horizon.

4. Towards an increasing social complexity.

5. Increasing use of cultural/historical knowledge to achieve the goal.

It is considered a core EF (Miyake et al., 2000) and some authors consider that all
other EF involve some kind of inhibition processes (Friedman & Miyake, 2017;
Hasher & Zacks, 1988).

Inhibition was present in early psychological theories (e.g., Ebbinghaus, 1885; James,
1890; Wundt, 1902; Freud, 1915; Pavlov, 1927).
e.g., Wundt (1902) claimed that selective
attention was accomplished by the active inhibition of unattended information.
 Cognitive inhibition
Behavioural inhibition
suppression of previously activated cognitive
overt behaviour control, such as
contents, clearing of non-relevant information
resistance of a prepotent response,
and resistance to interference of information
delay of a reward, motor inhibition,
from cognitive content that is contextually
and impulse control.
inadequate

(Koch et al. 2010; Bjorklund and Harnishfeger 1995)

Inhibition has a central role in the organization of various cognitive domains,

including attention, memory and language (MacLeod et al. 2003).

It may function at different levels of cognitive processing, such as thoughts,

verbal responses, visual processing, sounds, actions or semantic processing (Amieva et
al. 2004).
Inhibition has received labels such as “interference” (Piai et al. 2012) and “suppression”
(Ludowig et al. 2010) to highlight its automatic nature (implicit or unintentional inhibitory
processes) and controlled nature (explicit or intentional inhibitory processes),
respectively (Nigg 2000; Friedman and Miyake 2004; Andres et al. 2008; Collette et al. 2009; Pires et al., 2014).

Controlled and Automatic Human Information Processing Model

(Shiffrin and Schneider 1977)

Controlled inhibition is the conscious Automatic inhibition occurs without

and deliberate suppression of the subject’s awareness and appears
irrelevant stimuli or responses. to be involuntary (e.g., Negative Priming
(e.g., Stroop task - Stroop 1935) task - Tipper 1985)
Inhibition is a unitary process There are multiple components of
(Anderson & Levy, 2007; Aron et al., 2014; Logan,
Van Zandt, Verbruggen, & Wagenmakers, 2014;
the of inhibitory phenomena:
Wimber, Alink, Charest, Kriegeskorte, & Anderson,
2015) that integrates the following Automatic vs controlled inhibition
three different but related (Andres et al., 2008); response or motor

functions: inhibition (Robinson et al. 2013); lateral

inhibition (Bridgeman 2006); inhibition
1. the access function of return (Possin et al. 2009); semantic
2. the deletion function inhibition (Debruille 2007); proactive
3. the restrain function interference (Yi and Friedman 2011).
 But at what level inhibition
operates?

 Inhibition may function at different levels of cognitive processing, such as

thoughts, verbal responses, visual processing, sounds, actions or semantic processing
(Amieva et al., 2004; Pires et al., 2014).

Inhibition operates in low level Inhibition operates in higher level

cognitive processing, acting cognitive processing, acting directly
upon the representations of in attention, memory and language
distractors. processes

The Stroop task has been used to study inhibition mechanisms in both low and
higher level cognitive processing. (West and Alain, 1999; Liotti et al., 2000; Macleod, 2005;
Hanslmayar et al., 2008; Mayas et al., 2012; Li et al., 2013).
 The Stroop task
In the Stroop task, participants have to selectively attend to one particular
stimulus dimension (e.g., word color), and to ignore another stimulus dimension
(e.g., word shape associated with meaning) (Macleod et al., 2005).

1886 1935 1965 Tecce and 1969, White; 1970,71,

Cattel Stroop Dimartino’s Shor…
Individual-trial Spatial Stroop tasks
Stroop 1993 – Hartley
Dissociating Stroop
dimensions and
aging

1966 Dalrymple-Alford and

Budayr - Congruent
Condition and “Negative
Priming”

136 years of history…

In this task, coloured words are presented and the participant must
consciously inhibit the tendency to produce a more dominant automatic
response (i.e., naming the colour word) to be capable of naming the
colour of the ink in which the word is printed.
 Stroop interference sequential effects have been reported using the color-word
Stroop task (e.g., Kerns et al.,2004; Mayas et al., 2012).

Priming happens when a previous processing of a stimulus has an impact

on the subsequent processing of the same or a related stimuli (May, Kane and
Hasher, 1995).

RED
YELLOW
Negative Priming Sequence -
the irrelevant word on trial n-1
was the same as the relevant
colour on trial n. (May et al., 2012)
YELLOW
RED
Positive Priming Sequence - the
colours of the stimuli on trials n-1
and n were the same, but the colour
names were different. (Hodge, Salmon
and Collete, 2008)
Various versions of Stroop tests have been designed—emotional (Meier & Robinson, 2004),
auditory (Cohen & Martin, 1975), or spatial (e.g., White, 1969).

 The spatial Stroop tasks typically use verbal (e.g., left, right, above, bellow) or
symbolic stimuli (e.g., arrows), combining a semantic attribute that
designates spatial l0cation or direction with a physical stimulus position
attribute.

In a spatial Stroop task both the relevant and

irrelevant dimensions imply spatial
information
(Lu and Proctor, 1995).

 The spatial Stroop effect reflect primarily interference when the irrelevant
dimension is incongruent with the relevant dimension, but interference
appears to be less than for the Stroop colour-naming task, when we use (Hilbert
et al., 2014).
 What we know about the spatial Stroop effect?

 The response modality (e.g., vocal or keypress) determines which stimulus

dimension produces a significant spatial Stroop effect (Seymour, 1973; Logan, 1980; Virzi
& Egeth, 1985; Lu and Proctor, 2013).

 The spatial Stroop effect can be obtained with integrated and non-integrated
stimuli (Lu and Proctor, 1995).

 The spatial Stroop effect is a function not only of the degree of automaticity of the
pre-established S-R associations but also of attentional strategies used during
the task (e.g., precuing whether the forthcoming stimulus will be congruent or
incongruent facilitates response) (Lupiáñez and Funes, 2005; Funes et al., 2007; Lou et al., 2010;
Lou et al., 2013).
“Five Digit Test”, Test de los Cinco Dígitos (2007): TEA
Ediciones Madrid. – A numeric Stroop task

 Minimal non-reading lexical load (groups of 1 to 5 digits

or 1 to 5 stars, read or counted)
 Situations that require progressive mobilization of
executive effort (naming, persisting, selecting, switching)
 Increased response latencies and errors in subjects with
neuropsychological dysfunctions
 The test is composed of four parts; each of these parts is
composed of a series of 50 boxes that contain stimuli
similar to those presented.
 Population - 7 years old and above

Comparable to the Stroop Color-Word Test (SCWT; Stroop, 1935)

Part 1 – Decoding/Reading: "Read only the digit each box
contains"
 Part 1 – Decoding/Reading: "Read only the digit each box contains"

Tempo
Parte 1 - LEITURA Erros
(Segundos)

1 4 3 2 5 4 3 1 5 2 5 4 2 3 1 2 5 1 4 3 1 3 2 5 4

3 5 4 1 2 1 4 3 2 5 4 1 5 3 2 5 2 1 4 3 2 5 3 1 4
Part 2 – Retrieving/Counting: "Count how many asterisks (stars) each
box contains."
Part 2 – Retrieving/Counting: "Count how many asterisks (stars) each box
contains."

Tempo
Parte 2 - CONTAGEM Erros
(Segundos)

1 4 3 2 5 4 3 1 5 2 5 4 2 3 1 2 5 1 4 3 1 3 2 5 4

3 5 4 1 2 1 4 3 2 5 4 1 5 3 2 5 2 1 4 3 2 5 3 1 4
Part 3 – Inhibiting/Choosing: "Count how many digits each box
contains."
Part 3 – Inhibiting/Choosing: "Count how many digits each box
contains."

Tempo
Parte 3 - ELEIÇÃO Erros
(Segundos)

1 4 3 2 5 4 3 1 5 2 5 4 2 3 1 2 5 1 4 3 1 3 2 5 4

3 5 4 1 2 1 4 3 2 5 4 1 5 3 2 5 2 1 4 3 2 5 3 1 4
Part 4 - Shifting: "Count the digits as you did in the previous part, but
now, when you come to a box with a darker frame, you must change the
rule, and read the digit there instead."
Part 4 - Shifting: "Count the digits as you did in the previous part, but
now, when you come to a box with a darker frame, you must change the
rule, and read the digit there instead."

Tempo
Parte 4 - ALTERNÂNCIA Erros
(Segundos)

1 4 3 2 5 4 3 1 5 2 5 4 2 3 1 2 5 1 4 3 1 3 2 5 4

3 5 4 1 2 1 4 3 2 5 4 1 5 3 2 5 2 1 4 3 2 5 3 1 4
 INIBIÇÃO
_____________ - ______________ = ___________ (Percentil: ________ )
(Tempo Total (Tempo Total
Parte 3 – Eleição) Parte 1 – Leitura)

FLEXIBILIDADE
_____________ - ______________ = ___________ (Percentil: ________ )
(Tempo Total Parte (Tempo Total
4 – Alternância) Parte 1 – Leitura)
Small sample size but some data with FDT and other neuropsychological
measures. Pinto & Peixoto, 2011
Gerstadt, C. L., Hong, Y. J., & Diamond, A. (1994). The relationship
between cognition and action: Performance of children 3 1/2-7
years old on a Stroop-like day-night test. Cognition, 53(2), 129-153.
«The experimenter first presented children with two commands: “touch your head” and “touch your
toes.” Then children were told they were going to play a “silly” game and do the opposite of what
the experimenter says. For example, if they were told to “touch your head,” children should touch
their toes. There were 4 practice trials with feedback and then 10 test trials with no feedback.
Children received a 0 on any given trial if they gave an incorrect response (i.e., touching their head
when the experimenter asked them to touch their head). Children were given a 1 if they self-
corrected (i.e., began to touch their head, but then corrected to touch their toes). Two points were
given for fully correct responses. If children earned 4 or more points on the 10 test trials, the
experimenter continued to Part II. In Part II, the experimenter introduced two new rules: “touch your
shoulders” and “touch your knees.” If children scored > 4 points out of 10, they continued to Part III.
In Part III, all the rules the children had learned were scrambled, such that when the experimenter
told the children to “touch their head” they must touch their knees. Again, children were given 4
practice trials with feedback and 10 test trials. Points were summed from each part for a possible 60
points total. » (Distefano, Galinsky, McClelland, Zelazo, & Carlson, 2018).

Cameron Ponitz, C. E., McClelland, M. M., Jewkes, A. M., Connor, C. M.,

Farris, C. L., and Morrison, F. J. (2008). Touch your toes! Developing a
direct measure of behavioral regulation in early childhood. Early Child.
Res. Q. 23, 141–158. doi: 10.1016/j.ecresq.2007.01.004
Referências bibliográficas
 Nichelli, F., Scala, G., Vago, C., Riva, D., & Bulgheroni, S. (2005). Age-
related trends in Stroop and conflicting motor response task
findings. Child neuropsychology : a journal on normal and abnormal
development in childhood and adolescence, 11(5), 431–443.
https://doi.org/10.1080/09297040590951569
 Paiva, G. C. D. C., Fialho, M. B., Costa, D. D. S., & Paula, J. J. D. (2016).
Ecological validity of the five digit test and the oral trails test.
Arquivos de Neuro-Psiquiatria, 74(1), 29-34.
 Plata, V. A. (2013). Comportamiento psicométrico del Test de Cinco
Dígitos en niños con edades comprendidas entre los 5 y 6 años
(Master’s thesis). Universidad Católica Andrés Bello, Caracas,
Venezuela.
 Pinto, A., & Peixoto, B. (2011). Neurocognitive profile of children with
developmental dyslexia. Journal of Health Science, 1(3), 115-125.
 Cameron Ponitz, C. E., McClelland, M. M., Jewkes, A. M., Connor, C.
M., Farris, C. L., and Morrison, F. J. (2008). Touch your toes!
Developing a direct measure of behavioral regulation in early
childhood. Early Child. Res. Q., 23, 141–158. doi:
10.1016/j.ecresq.2007.01.004
30 30
Luís Pires
lpires@fpce.uc.pt
NEUROPSYCHOLOGICAL REPORTS

“Effective psychological reports are readable,

connect to the person’s context, have clear links
between the referral questions and the answers to
these questions, have integrated interpretations, and
address client strengths as well as problem areas”.

(Groth-Marnat, 2009)

32
 NEUROPSYCHOLOGICAL REPORTS
Functions:
1. Increase the understanding of clients, their parents (in
case of children), and other professionals (including
teachers) about clients’ strengths and adaptive skills;
cognitive, academic, and social-emotional difficulties; and
the environmental factors that impede and enhance
learning and social-emotional adjustment.
2. Provide viable recommendations for accommodations
and interventions that are tailored to the needs of the
client and communicate the diagnostic information
and recommendations in ways that they are understood,
appreciated, and implemented.
3. To provide a long-term record that can be used to access
treatment and accommodations
(Harvey, 2006)

33
 NEUROPSYCHOLOGICAL REPORTS
Reports will differ with:
 Practice setting (e.g., school, clinic)

 Purpose of the evaluation (e.g., treatment

planing)
 Target readership (e.g., attourneys,
psychatrists)
 Consumer or payor requirments (e.g.,
insure companies)
 Writer's level of expertise

 Personal Preference (e.g., narratve vs

bullet points)

34
 NEUROPSYCHOLOGICAL REPORTS
A report can only be as good as the information on which it
is based, so:
 Understand the referral question.

 Know what your role is (e.g., a second opinion)

 Be familiar with the condition of interest.

 Review all relevant records.

 Do a thorough interview and history.

 Consider behavioural observations.

 Use appropriate and validated tests.

 Analysis of test results (formal tests, recognized and accepted in a

professional context, with available standards, administered and scored according
to standardization rules)

35
 NEUROPSYCHOLOGICAL REPORTS
The most important feature of a Neuropsychological
Report:
INTEGRATION
 Answer the referral question in the clearest most
evidence-based and succinct way.
 What else should the reader know?

 What is the follow-up plan?

 Don'tjust regurgitate, offer something that is of

incremental value.
 Keep the recommendations realistic.

36
 NEUROPSYCHOLOGICAL REPORTS
Inverted pyramid model (Donders, 2016).
Start by formulation the 1-3 main points you eventually
want to make.
Then determine what would be key aspects of the history,
observations or data that you would need to emphasize to
support each of those points.
Then decide if there really is anything else you should
include in your report.

37
 CONTEXT OF INTERPRETATION OF RESULTS
▸ INTERVIEW(S):
o Reason for the Assessment
o History (developmental, clinical/medical, educational/school, family,
social, emotional, …)
o Medical or school exams and reports

▸ Use of several interlocutors:

o Parents
o Teachers
o Child or adolescent

▸ BEHAVIOR OBSERVATION:
o Important in the qualitative analysis of the performances in the different
BANC tests

▸ Integration of results and information obtained in the remaining

evaluation protocol carried out:
o WISC-III* or WPPSI-R
o Other tests/instruments: D2, Reading tests, Conners, CBCL, TRF, SCICA,
YSR, CDI, STAI-C, PHSCS-2, ...
38
 NEUROPSYCHOLOGICAL REPORTS
Technical aspects of report writing
 Write short but complete sentences.

 Present one main idea per paragraph, woth a few

supporting sentences.
 Use transition sentences to either change topic or to
highlight contrasts.
 Do not use passive voice; phrase actively.

 Maintain the same tense.

39
 NEUROPSYCHOLOGICAL REPORTS
Technical aspects of report writing
 Avoid jargon; if you have to use it, define it.

 Don't use ambigous terms, vague qualifiers or double

negatives.
 Integrate sections from eralier parts but don't throw out
'teasers' for later parts.
 Cut down on unnecessary detail.

 End with a bottom line/take home mesage that ansewrs

the referral question.

40
 NEUROPSYCHOLOGICAL REPORTS
Ethical and professional issues
 Document informed consent.

 Maintain a professional composure.

 Minimize intrusions on privacy.

 Ok to append test summary list but maintain test security.

 Include only conclusions that can be substantiated by your

data and/or the current state of the scientific knowledge.

41
 NEUROPSYCHOLOGICAL REPORTS
Recommendations
Put all your documents in a logical order.

Make an outline or diagram first.

Know exactly what main points you want to make and how
to support them.
Reports should be readable, objective, and appropriately
comprehensive.Write clearly and concisely.
Think of what you would do if you were limited in time
(100 seconds) or in writing space (100 words).
Present only the most critical information to allow for
rapid and timely feedback.

42
Referências bibliográficas
 Donders, J. (Ed.) (2016). Neuropsychological report writing. New
York: Guilford.
 Groth-Marnat, G. & Davis, A. (2014). Psychological report writing
assistant.
 Schneider, W. J., Lichtenberger, E.O., Mather, N., & Kaufman,
N.L. (2018). Essentials of assessment report writing (2nd ed.).
New York:Wiley.
 Simões, M. R.. Relatórios psicológicos: Teoria, prática e
investigação (Livro em preparação).
 Simões, M. R., & Sousa, L. B. (2011). Traumatismos crânio-
encefálicos no âmbito do Direito de Trabalho: Avaliação
(neuro)psicológica e elaboração de relatório para tribunal.
In M. Matos, Rui A. Gonçalves, & C. Machado (Coords.), Manual
de Psicologia Forense: Contextos, prática e desafios (pp. 351-
374). Braga: Psiquilibrios Edições.
43 43