1. OCCUPATIONAL THERAPY PROGRAM, DEPARTMENT OF KINESIOLOGY, UNIVERSITY OF WISCONSIN-MADISON
Protocol Development for Executive Functioning
Tasks in Children with Typical Development
Kate
Mroczynski,
OTS
&
Elizabeth
Larson,
PhD,
OTR
Acknowledgments
References
Results Conclusions
Research Design & Methods
Implications for Practice
Introduction
• Executive functioning (EF): an individual's ability to construct,
act and follow through on a thought
• EF is essential to functional independence and deficits may be
felt in areas such as communication, behavior and social
interactions
• Many assessments attempt to assess EF capabilities in an
ecologically valid manner but fail making targeted interventions
of specific EF components difficult
• The original Children’s Kitchen Task Assessment (CKTA)
requires a child to make play dough from a recipe; this
performance based test of children’s EF skills has high
ecological validity
• A 2nd CKTA of making a mug cake in the microwave was
created to allow assessors to measure a child’s EF capabilities
over a period of time accounting for learning effects
• It was hypothesized that if each task was parallel in difficulty, a
participant would score similarly on each CKTA task
Thank you very much to my research mentor Dr. Elizabeth Larson
for her time, guidance and knowledge contributed to the project.
Thank you to Dr. Brittany Travers for her insight and expertise.
Thank you to my fellow research partner Ted Elias for your hard
work and dedication. Also, thank you to my fellow research
teammates Brittany Ewert and Andrea Cook.
Design
• Exploratory protocol development study to design a 2nd CKTA
Participants
• Two children aged 8 years (50% female) from the Madison area with
typical development to establish normative data
Procedures
• A 2nd task (mug cake) was developed based on an analysis of EF
components in the original CKTA (play dough)
• To ensure equivalence in complexity, criteria for new task:
• Safety element & waiting period to test inhibition
• Novel & motivating for children
• Approximately 4 ingredients, 20 steps & 20 minutes long
• Ingredients could not contain common allergens, toxins or
require refrigeration
• Developed recipe book, scoring sheet, cueing sheet, pre- and post-
task surveys
• Scores derived from the number of verbal and non-verbal cues
needed to complete the task and were weighted for increasing levels
of assistance (1-5); range 0-400 points
• Established assessor reliability using play dough task, rating video
recordings and comparing to expert assessor (r = .98)
• Assessed participants on both tasks which were counterbalanced for
order and video recorded
Validation Measures (BRIEF)
• Parent completed standardized questionnaire assessing a child’s EF
skills in various environments
Data Analysis
• A descriptive analysis was performed based on participants’ answers
from the surveys and BRIEF as well as a qualitative coding of the
video recordings
• EF skills need to be clearly assessed in an ecologically valid
manner for functional independence, the original CKTA task of
making play dough fulfills this goal for children
• A 2nd CKTA was designed based on an analysis of the original
CKTA
• In initial testing, similar scores across the two tasks were
demonstrated for the two participants
• The 2nd CKTA of making a mug cake appears similar in its EF
demands to the original CKTA of making play dough
• Additional research is needed for normative data replicating
results with a larger, more diverse sample size
• The play dough and the mug cake task could be used to test a
child’s EF capabilities in an ecologically valid manner over a
period of time accounting for learning effects
• These new tasks could provide insight into interventions in
which therapists could target specific EF deficits that impact a
child’s functioning in daily life
• These newly developed tasks would be appropriate for use in
school based or clinic settings
Table 1
Overall Scores & Demographics
Play Dough Task Mug Cake Task
Participant A
(8 years, Female, 2nd grade)
• Score 5 2
• Time 13:29 13:19
• Total cues required 4 2
• Highest cue required Gesture guidance Verbal guidance
• Overall organization score 1 1
Participant B
(8 years, Male, 2nd grade )
• Score 0 0
• Time 12:37 13:55
• Total cues required None None
• Highest cue required N/A N/A
• Overall organization score 1 1
1. Baum, C., & Edwards, D. (1993). Cognitive performance in senile dementia of
the Alzheimer's type: the Kitchen Task Assessment. American Journal Of
Occupational Therapy, 47(5), 431-436.
2. Berg, C., Edwards, D., & King, A. (2012). Executive function performance on
the children’s kitchen task assessment with children with sickle cell disease and
matched controls. Child Neuropsychology, 18(5), 432-448. doi:
10.1080/09297049.2011.613813
3. Memisevic, H. H., & Sinanovic, O. O. (2014). Executive function in children
with intellectual disability -- the effects of sex, level and aetiology of
intellectual disability. Journal Of Intellectual Disability Research, 58(9),
830-837. doi:10.1111/jir.12098
4. Lezak, M. D. (1982). The problem of assessing executive functions.
International Journal Of Psychology, 17(2/3), 281.
5. Rocke, K., Hays, P., Edwards, D., & Berg, C. (2008). Development of a
performance assessment of executive function: the Children's Kitchen Task
Assessment. American Journal Of Occupational Therapy, 62(5), 528-537.
Note. Scores >65 indicate clinical significance. Participant A’s performance on the BRIEF is
qualitatively similar to each CKTA performance. Participant B scored significantly on the
inhibition subscale of the BRIEF but did not did not exhibit difficulty during the waiting periods
of either CKTA task. This may demonstrate his capacity to self-regulate in some contexts and not
others.
Note. In the video analysis of each performance, each subscale of EF was present in both the play
dough and mug cake task with specific times recorded to document the parallel demands
Figure 2.
Participant A Mug Cake Score SheetChildren’s KTA- Mug Cake Score Sheet Date: _________
Participant ID # _________ Tester’s Initials: ________
Task:
Mug Cake
Independent
0
Verbal
Guidance
1
Gesture
Guidance
2
Direct Verbal
Instructions
3
Physical
Assistance
4
Do For
Participant
5
Score
INITIATION: Beginning the task
Upon the request to start, subject moves to gather
materials/recipe for making cup cake.
X
EXECUTION: Carrying out the activities of the task
through the use of organization, sequencing and
judgment
Plan/Sequencing:
1. Adding ingredients. A-C:
a. Add ¼ cup chocolate chips to cup
X
b. Add 3 tbs. of water to cup X
c. Add 2 tsp. of hot chocolate mix to cup XX X
2. Stir with spoon until mixed X
3. Microwave cup for 30 seconds X
4. Wait 1 minute, Use timer X
5. Pull out of microwave X
6. Stir with spoon until mixed X
7. Add 3 tbs. flour to cup X
8. Add ¼ tsp. baking soda to cup X
9. Stir with spoon until mixed X
10. Microwave cup 1 minute X
11. Wait 3 minutes, Use timer X
Judgment & Safety (Inhibition)- Avoidance
of dangerous situation.
Participant prevents or avoids danger, e.g., able to
determine when the mug cake is safe to eat, careful with
the heating of the cup, etc.
X
COMPLETION: Termination of the task.
Participant knows he/she is finished as
demonstrated by packing the mug cake to go.
X
Total Amount of Cues Required: __4___ Time:___13:29___ Total Score: ___5___
Highest Level of Cue Required: ___Gesture Guidance___ Organization score ___1___
30
40
50
60
70
80
90
100
Executive Function Subscale
Participant A
Participant B
Figure 1.
Profiles of BRIEF Scores
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