Date Presented 04/07/19
We describe a new approach for assessing executive functions in everyday life and its unique expression in adolescents with epilepsy, using the Weekly Calendar Planning Activity (WCPA). The WCPA provides functionally relevant information on task performance and strategy use that can guide intervention and measure outcomes. We recommend that OTs assess EF among adolescents with epilepsy using a performance-based assessment.
Primary Author and Speaker: Sharon Zlotnik
Contributing Authors: Aharon Schiff
Sarit Ravid, Eli Shahar, Joan Toglia
PURPOSE: The study objective was to assess Executive Functions (EF) and strategy use in everyday life among adolescents with Genetic Generalized Epilepsy (GGE), compared to typical peers, using a performance-based assessment. Epilepsy is a common chronic neurological disorder, characterized by recurrent seizures. An estimated 2.4 million new cases occur each year globally; at least 50% of cases begin in childhood or adolescence (WHO, 2017). Executive dysfunction has been identified in adolescents with GGE (Rathouz et al., 2014). An important aspect of EF is the effective use of strategies to successfully manage challenges in performing daily life activities. A performance-based assessment such as the Weekly Calendar Planning Activity -WCPA (Toglia, 2015), provides an in-depth information about how one goes about performing a task including information on strategies used, types of errors, and ability to recognize and correct errors can be directly observed. This information is particularly relevant to designing intervention programs. There is very little research on performance and strategies used by adolescents outside the context of specific academic subjects, despite the recognition that effective strategies are needed for success in daily life, and there are no studies to date that have investigated strategy use in adolescents with epilepsy.
DESIGN: Descriptive, groups comparison.
METHOD: Participants: The study group included 20 adolescents (12 girls, 8 boys) (mean age 15.78 years, SD=1.53) with a diagnosis of GGE. The control group included 20 healthy peers (12 girls, 8 boys) (mean age 15.94 years, SD=1.52) matched to the study group by age and gender. Participants with a learning disability, additional chronic illnesses and previous diagnosis of ADHD were excluded from the study. Assessments of everyday EF were: 1). The Weekly Calendar Planning Activity-WCPA (Toglia, 2015). 2). The Behavior Rating Inventory of Executive Function – BRIEF (Gioia et al., 2000) - parental rating. Statistical analysis: Nonparametric Mann-Whitney U test was used to examine differences between the groups. Correlations between the BRIEF and WCPA were measured using the non-parametric Spearman test.
RESULTS: Adolescents with GGE demonstrated significantly less accuracy (U=66.0, Z=-3.66 p<.01(, less efficiency (U=83.0, Z=-3.16, p<.01), different and less number of strategies (U=107.0, Z=-2.38, p<.05) compared to controls. The greatest discrepancy of strategy use was noted in "Self-checks" strategy; 60% of the control group used this specific strategy, yet, only 30% of the participants with epilepsy used it. Parents of adolescents with GGE rated more frequent EF symptoms within their child's daily performance, compared to controls. Significant correlations were found between the WCPA number of accurate meetings and the BRIEF subscales GEC (rs=-.39, p<0.05) and MI (rs=-.41, p<0.05). Better parental ratings of executive function were associated with greater accuracy in entered appointments to the WCPA.
CONCLUSION: The WCPA provides a useful evaluation of cognitive performance for adolescents with GGE and functionally relevant information on task efficiency, self-monitoring and effective strategy use. Direct observation of performance supplements parental ratings and has strong potential to guide intervention and measure outcomes. We recommend that occupational therapists assess EF among adolescents diagnosed with GGE, using a performance-based assessment, in order to plan useful intervention strategies for those adolescents who have impaired EFs, to enhance their outcomes across broad areas of function.
References
Gioia, G. A., Isquith, P. K., Guy, S. C., & Kenworthy, L. (2000). Test review behavior rating inventory of executive function. Child Neuropsychology, 6(3), 235-238. ? DOI: 10.1076/chin.6.3.235.3152
Rathouz, P. J., Zhao, Q., Jones, J. E., Jackson, D. C., Hsu, D. A., Stafstrom, C. E., ... & Hermann, B. P. (2014). Cognitive development in children with new onset epilepsy. Developmental Medicine & Child Neurology, 56(7), 635-641. DOI: 10.1111/dmcn.12432 ?
Toglia, J. (2015). Weekly calendar planning activity?: a performance test of executive function. AOTA Press.
World Health Organization (WHO), (2017). Epilepsy fact sheet [http://www.who.int/mediacentre/factsheets/fs999/en/]
