Child Neuropsychology

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Assessment and Development of Executive

Function (EF) During Childhood

Peter Anderson

To cite this article: Peter Anderson (2002) Assessment and Development of Executive Function
(EF) During Childhood, Child Neuropsychology, 8:2, 71-82, DOI: 10.1076/chin.8.2.71.8724

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 Child Neuropsychology 0929-7049/02/0802-071$16.00
2002, Vol. 8, No. 2, pp. 71–82 # Swets & Zeitlinger

Assessment and Development of Executive

Function (EF) During Childhood
Peter Anderson1,2
1
Department of Psychology, Royal Children’s Hospital, Murdoch Childrens Research Institute, Parkville,
Australia, and 2Department of Psychology, The University of Melbourne, Australia

ABSTRACT

This review paper outlines the issues associated with the assessment of executive function (EF) in children
and adolescents, and describes the developmental profile of executive processes across childhood. At the
outset, EF is defined, and cognitive and behavioral impairments associated with executive dysfunction (EDF)
are described. A developmental model of EF is proposed incorporating four discrete but inter-related
executive domains (attentional control, cognitive flexibility, goal setting, and information processing) which
operate in an integrative manner to enable ‘‘executive control’’. Characteristics that constitute traditional EF
measures are discussed, as are the problems associated with test interpretation. The ecological validity of EF
tests and neuropsychological assessment procedures are examined, and adjunct methods of measurement are
presented to enable a more comprehensive and valid assessment of EF. Based on developmental and
normative studies, the maturation of executive domains is mapped. Attentional control appears to emerge in
infancy and develop rapidly in early childhood. In contrast, cognitive flexibility, goal setting, and
information processing experience a critical period of development between 7 and 9 years of age, and are
relatively mature by 12 years of age. A transitional period is thought to occur at the beginning of
adolescence, and shortly after ‘‘executive control’’ is likely to emerge. In order to confirm our current
understanding of EF development and further enhance our understanding of brain-behavior relationships,
longitudinal studies incorporating structural and functional neuroimaging are required.

Executive function (EF) is an umbrella term that tion of feedback. Executive processes develop
incorporates a collection of inter-related pro- throughout childhood and adolescence, and play
cesses responsible for purposeful, goal-directed an important role in a child’s cognitive function-
behavior (Gioia, Isquith, & Guy, 2001). These ing, behavior, emotional control, and social
executive processes are essential for the synthesis interaction.
of external stimuli, formation of goals and The anterior regions of the brain are thought
strategies, preparation for action, and verification to mediate executive functioning as deficits in
that plans and actions have been implemented executive skills often follow damage to the pre-
appropriately (Luria, 1973). Processes associated frontal cortex (e.g., Grattan & Eslinger, 1991;
with EF are numerous, but the principle elements Stuss & Benson, 1986). Supporting this view,
include anticipation, goal selection, planning, functional neuroimaging studies have observed
initiation of activity, self-regulation, mental significant activation within the prefrontal cortex
flexibility, deployment of attention, and utiliza- in individuals performing EF tests (e.g., Baker

Address correspondence to: Peter Anderson, Department of Psychology, Royal Children’s Hospital, Murdoch
Childrens Research Institute, Flemington Road, Parkville 3052, Vic., Australia. E-mail: [email protected].
unimelb.edu.au
Accepted for publication: September 10, 2002.
72 PETER ANDERSON

et al., 1996; Morris, Ahmed, Syed, & Toone, Grattan & Eslinger, 1992). Children exhibiting
1993; Rezai et al., 1993). The neural systems EDF may present as apathetic, unmotivated, and
underpinning EF are numerous, complex and unresponsive, however, others may be impulsive
inter-related with the prefrontal cortex dependent and argumentative. Some children with executive
on efferent and afferent connections with virtually impairment ask embarrassing or socially inap-
all other brain regions including the brain stem, propriate questions and make hurtful statements,
occipital, temporal, and parietal lobes, as well as suggesting a lack of insight and intuition. They
limbic and subcortical regions (Stuss & Benson, may also struggle to appreciate humor or tell
1984). Damage or loss of function at any level of distasteful jokes. Disregarding the consequences
one of these neural systems may result in cogni- of actions and ignoring social rules and conven-
tive and/or behavioral deficits. As a consequence tions may also be an indication of EDF. Inflex-
of this complex neural network, executive dys- ibility and rigidity in children is often manifested
function is not always associated with prefrontal by a resistance to change activities, an inability to
pathology directly, but may be related to network modify previously learned behaviors, and a fail-
disconnections such as white matter damage or ure to learn from mistakes. Not surprisingly, many
impairment to other brain regions (Alexander & children exhibiting EDF display poor interperson-
Stuss, 2000; Eslinger & Grattan, 1993). In sum- al skills and experience difficulties maintaining
mary, it may be argued that the integrity of the meaningful social relationships.
prefrontal cortex is a necessary, but not a suffi- Executive impairments have been re-
cient, condition for intact executive functioning ported in numerous pediatric clinical popula-
(Della Sala, Gray, Spinnler, & Trivelli, 1998). tions such as attention deficit hyperactivity
disorder (Grodzinsky & Diamond, 1992), au-
Executive Dysfunction (EDF) tism (Bishop, 1993), bacterial meningitis
Executive dysfunction (EDF) is not a unitary (Taylor, Schatschneider, Petrill, Barry, & Owens,
disorder (Gioia et al., 2001). It represents deficits 1996), dyslexia (Levin, 1990), head injury (Garth,
in one or more elements of EF and a variety of Anderson, & Wrennall, 1997), frontal lobe lesions
presentations is possible. In children, cognitive (Eslinger, Biddle, Pennington, & Page, 1999),
deficits that may be associated with EDF include hydrocephalus (Fletcher et al., 1996), insulin
poor impulse control, difficulties monitoring or dependent diabetes mellitus (Northam et al.,
regulating performance, planning and organiza- 2001), and phenylketonuria (Welsh, Pennington,
tional problems, poor reasoning ability, difficul- Ozonoff, Rouse, & McCabe, 1990). The range of
ties generating and/or implementing strategies, pediatric conditions exhibiting EDF is to be
perseveration and mental inflexibility, poor utili- expected given the array of skills and behaviors
zation of feedback, and reduced working memory. that are associated with EF. However, the chal-
In a developmental context, some of these lenge is not identifying EDF, but determining the
behaviors may not be considered ‘deviant,’ as in nature of the impairment and the underlying
the case of an infant or young child. Therefore, it neural pathology, as this determination will
is critical that developmental expectations of greatly influence intervention and treatment
executive processes are well understood. plans.
EF is not exclusive to cognitive processes,
but is also implicated in emotional responses Conceptualization of EF
and behavioral actions (Gioia, Isquith, Guy, & Traditionally, EF has been conceptualized as a
Kenworthy, 2000). In particular, mood, affect, single construct, being the central executive
energy level, initiative, and moral and social responsible for multi-modal processing and
behavior can be disrupted in children and adults high-level cognitive skills (Della Sala et al.,
exhibiting EDF (Anderson, Bechara, Damasio, 1998; Shallice, 1990). However, EF has also been
Tranel, & Damasio, 1999; Barrash, Tranel, & conceptualized as multiple process related sys-
Anderson, 2000; Eslinger & Damasio, 1985; tems, that are inter-related, inter-dependent and
Eslinger, Grattan, Damasio, & Damasio, 1992; function together as an integrated supervisory or
 ASSESSMENT AND DEVELOPMENT OF EF 73

Fig. 1. Proposed model of executive function.

control system (Alexander & Stuss, 2000; Stuss & Based on factor analytic studies and current
Alexander, 2000). This latter framework is clinical neuropsychological knowledge, a model
probably more accurate given that global execu- of EF is proposed (see Fig. 1). In line with the
tive impairment is rare, specific executive pro- views of Alexander and Stuss (2000), this model
cesses are thought to be associated with distinct conceptualizes EF as four distinct domains: (i)
frontal systems, and executive processes demon- attentional control, (ii) information processing,
strate variable developmental profiles. (iii) cognitive flexibility, and (iv) goal setting.
In general, developmental models of EF have These executive domains are considered discrete
been derived from factor analytic studies using functions that are likely to be related to specific
outcome parameters from EF test batteries (Kelly, frontal systems. However, they operate in an
2000; Levin et al., 1991; Welsh, Pennington, & integrative manner in order to execute certain
Groisser, 1991). These studies found that vari- tasks, and together they can be conceptualized
ables from EF tests loaded on three to four factors, as an overall control system. Attentional control
suggesting that it may be possible to identify processes greatly influence the functioning of the
specific executive domains and develop an other executive domains, while information pro-
empirically validated model of EF. Interestingly, cessing, cognitive flexibility, and goal setting
similar executive factors were reported across domains are inter-related and inter-dependent.
studies despite variations in test batteries and Each domain involves highly integrated cognitive
small samples across a wide age range. For processes, and each receives and processes stim-
instance, all three factor analytic solutions uli from various sources.
describe a ‘‘planning’’ factor (Kelly, 2000; The attentional control domain includes the
Levin et al., 1991; Welsh et al., 1991), while capacity to selectively attend to specific stimuli
two solutions refer to impulse control (Levin and inhibit prepotent responses, and the ability to
et al., 1991; Welsh et al., 1991), concept reason- focus attention for a prolonged period. Atten-
ing (Kelly, 2000; Levin et al., 1991) and response tional control also involves the regulation and
speed (Kelly, 2000; Welsh et al., 1991). monitoring of actions so that plans are executed
74 PETER ANDERSON

in the correct order, errors are identified, and task as routine, overlearned, complex, or novel is
goals are achieved. Individuals with impairments not always straightforward as what may be
in this domain are likely to be impulsive, lack complex or novel for one person may be simple
self-control, fail to complete tasks, commit pro- or routine for another (Alexander & Stuss, 2000).
cedural mistakes which they fail to correct, and Furthermore, some theorists claim that all cogni-
respond inappropriately. tive tests involve executive functioning to some
In the proposed EF model, information proces- extent (Alexander & Stuss, 2000; Della Sala et al.,
sing refers to fluency, efficiency and speed of 1998; Denckla, 1994).
output. The status of the information processing
domain reflects the integrity of neural connections
Test Interpretation
and the functional integration of frontal systems,
Most current EF tests involve complex, demand-
and can be evaluated by the speed, quantity and
ing and multi-faceted tasks that tap both executive
quality of output. Information processing deficits
and non-executive processes, and accordingly,
include reduced output, delayed responses, hesi-
these tests are sensitive to cognitive impairment.
tancy, and slowed reaction times.
However, fractionating the influence of various
Cognitive flexibility refers to the ability to shift
cognitive processes when interpreting task per-
between response sets, learn from mistakes,
formance is difficult, and consequently, these tests
devise alternative strategies, divide attention,
often lack the capacity to differentiate specific
and process multiple sources of information con-
cognitive deficits. An over-reliance on quantita-
currently. In this model, working memory is also
tive data when interpreting performance may
an element of the cognitive flexibility domain.
limit a test’s diagnostic utility since personal and
Inflexible individuals are generally considered
situational factors as well as important task
rigid and ritualistic, struggling when activities or
behaviors are not taken into account. To over-
procedures are changed and failing to adapt to
come this limitation, test performance may be
new demands. Impairment in this domain is often
judged using a micro-analytic approach that
associated with perseverative behavior, with indi-
incorporates quantitative (e.g., success/failure,
viduals continuing to make the same mistake or
latency, number of errors, etc.), qualitative (e.g.,
break the same rule.
motivation, energy, attention, distractions, etc.)
The goal setting domain incorporates the abil-
and cognitive-process (e.g., process, strategies,
ity to develop new initiatives and concepts, as
actions, etc.) methodologies. ‘‘Scoring systems’’
well as the capacity to plan actions in advance and
devised to record as much information about task
approach tasks in an efficient and strategic man-
performance as possible are likely to enhance the
ner. Impairments in this domain will result in poor
diagnostic utility of EF tests.
problem solving ability as reflected by inadequate
planning, disorganization, difficulties developing
efficient strategies, reliance on previously learned Ecological Validity
strategies, and poor conceptual reasoning. Inconsistencies between performance on tradi-
tional EF measures and real life behavior are often
Assessment of EF described (Eslinger & Damasio, 1985; Levine
It is argued that executive skills are activated in et al., 1998). For example, patients with a history
novel or complex tasks as they require the of severe behavioral problems may behave
individual to formulate new plans and strategies impeccably in clinic, or correctly answer ques-
and monitor their effectiveness, while simple or tions about social and moral dilemmas, but lack
routinized tasks are performed instinctively and judgment and self-regulation when faced with
without the activation of executive processes similar situations in real-life (Mesulam, 1986).
(Shallice, 1990). Consistent with this premise, The ecological validity of EF tests comes into
Walsh (1978) states that in order to assess EF a question by the very nature of their design, which
test needs to be novel, complex, and involve the requires novelty. In addition, neuropsycholog-
integration of information. However, defining a ical assessments are typically administered in
 ASSESSMENT AND DEVELOPMENT OF EF 75

well-structured and quiet settings with minimal The majority of EF tests used in the assessment
distractions (Sbordone, 2000), and are unlikely to of children have been developed and validated in
be representative of home, classroom, or social adult populations. In some cases, scaled-down
environments. In the assessment process the versions of adult measures have been devised
examiner provides support and encouragement (Gnys & Willis, 1991). However, adult-derived
(Sbordone, 2000), and plans and initiates activ- tests may be of little interest or relevance to young
ities (Anderson, 1998), often becoming the children, and they often lack adequate normative
‘‘frontal lobes’’ of the patient (Stuss & Alexander, data necessary to differentiate normal and abnor-
2000). In summary, the one-to-one environment is mal performance within a developmental context
rarely available in real-life settings, and in (Anderson, 1998). Furthermore, the practice of
some instances, may enhance motivation and using either adult-derived tests or scaled-down
performance. versions in children is questionable, particularly
If the ability of neuropsychological test data to for diagnostic purposes, as adult measures may
predict everyday behaviors is modest (Sbordone tap different skills in children and it is yet to be
& Guilmette, 1999), other sources of information proven that localized dysfunction in adults can be
are necessary. Given that EDF affects academic generalized to children (Anderson, 1998; Fletcher
progress and adaptive functioning, assessment of & Taylor, 1984).
EF should always include family and school In the last decade a number of tests have been
interviews as well as qualitative observation devised specifically for particular age ranges
(Bigler, 1988; Parker & Crawford, 1992). Behav- through childhood (e.g., Anderson, Anderson,
ioral inventories, such as the Behavior Rating Northam, & Taylor, 2000; Delis, Kaplan, &
Inventory of Executive Function (BRIEF; Gioia Kramer, 2001; Espy, 1997; Gerstadt et al., 1994;
et al., 2000), are often an useful adjunct to Jacobs, Anderson, & Harvey, 2001; Jacques &
cognitive assessments as they enable behavioral Zelazo, in press; Korkman, Kirk, & Kemp, 1998).
and qualitative information to be collected and However, as cognitive functions develop rapidly
interpreted in a standardized format. The BRIEF in children, it is difficult to devise tasks that
is a recently developed questionnaire for parents are suitable across the developmental spectrum.
and teachers of school age children, and provides Additional factors need to be addressed when
a profile of EF behaviors in home, school, and interpreting the performance of children on neu-
social environments. The level of agreement ropsychological tests such as the developmental
between the BRIEF and well-established EF cog- rate of specific skills, and the effects of brain
nitive tasks is at best modest (Anderson, Anderson, injury on subsequent development. Thus, validat-
Jacobs, Northam, & Mickiewicz, 2002), support- ing assessment tools within a developmental
ing the view that each form of assessment pro- framework is often more difficult than similar
vides unique information. attempts with adult populations.

Assessment of Pediatric Populations Development of EF

There is now compelling evidence that executive One of the challenges for understanding EF in
processes emerge in infancy and develop through- children is that these skills develop rapidly
out childhood into early adulthood (Anderson, through childhood, with the suggestion that
1998; Diamond & Taylor, 1996; Espy, 1997; progression is not necessarily linear, but may
Gerstadt, Hong, & Diamond, 1994). As these occur in spurts. Further, it appears that compo-
skills are vulnerable to early brain damage nents of EF might demonstrate different develop-
(Mateer & Williams, 1991) and important for mental trajectories, adding to the complexity of
ongoing cognitive development and academic the domains. Given that executive processes are
achievement (Dennis, 1989), standardized EF dependent on the integrity of frontal lobe systems,
measures are required that are suitable for it is likely that these skills will demonstrate
children and valid for specific developmental functional improvements that can be aligned
stages. with neurophysiological developments within
76 PETER ANDERSON

the prefrontal cortex. Interestingly, the develop- normative studies. Integrating these findings is
ment of the frontal lobes extends into adulthood problematic, however, there is sufficient evidence
(Hudspeth & Pribram, 1990; Orzhekhovskaya, to suggest that specific executive processes come
1981; Thatcher, 1991, 1997; Yakovlev & Lecours, on-line at different ages and exhibit variable
1967). Early claims that executive processes did developmental trajectories.
not emerge functionally until the frontal lobes
reached maturity in the second decade of life Attentional Control
(Golden, 1981) have now been refuted. For Infants younger than 9 months of age have
example, neuroimaging studies have demon- difficulty inhibiting previously learned responses,
strated prefrontal activation in infancy (Bell & but by 12 months of age most infants can inhibit
Fox, 1992; Chugani, Phelps, & Mazziotta, 1987), certain behaviors and shift to a new response
while neuropsychological studies have illustrated set (Diamond, 1985; Diamond & Doar, 1989;
functional developmental changes on EF tests Diamond & Goldman-Rakic, 1989). By 3 years of
across childhood (Becker, Isaac, & Hynd, 1987; age children inhibit ‘‘instinctive’’ behaviors
Levin et al., 1991; Passler, Isaac, & Hynd, 1985; reasonably well, although they continue to make
Welsh et al., 1991). Although research indicates the occasional perseverative error (Diamond &
that executive processes are present early in life Taylor, 1996; Espy, 1997). Improvements in
and improve throughout childhood, the develop- speed and accuracy on impulse control tasks can
mental profile of these skills is still unclear. be observed up to 6 years of age (Diamond &
Intuitively, one may expect functional improve- Taylor, 1996; Espy, Kaufmann, McDiarmid, &
ments in executive skills to be associated with Glisky, 1999). Children aged 9 years and older
increased maturity of anterior, posterior and tend to monitor and regulate their actions well,
subcortical brain regions, as well as the refine- although an increase in impulsivity occurs for a
ment of local connections within the prefrontal short period around 11 years of age (Anderson,
cortex and distal connections between the pre- Anderson, & Lajoie, 1996; Anderson et al., 2000).
frontal cortex and sensory, motor and association
regions. Information Processing
Although most cognitive skills emerge in early In early childhood, increments in response speed
childhood, a significant period of development and verbal fluency are observed, especially
occurs before it is fully functional. Dennis (1989) between 3 and 5 years of age (Espy, 1997;
proposes that this period of skill development can Gerstadt, Hong, & Diamond, 1994; Welsh et al.,
be divided into three sequential stages, emerging 1991). Processing speed and fluency continues to
(early stage of acquisition and not yet functional), improve during middle childhood (Anderson
developing (capacity is partially acquired but et al., 2000; Hale, 1990; Welsh et al., 1991), with
not fully functional), and established (ability significant gains in processing speed observed
fully mature). Only functional skills are assess- between 9–10 years and 11–12 years (Kail, 1986).
able (skills in the developing and established Improvements in efficiency and fluency oc-
stages), and the impact of brain insults on imma- cur during adolescence (Anderson, Anderson,
ture skills may not be realized until later in Northam, Jacobs, & Catroppa, 2001; Kail, 1986;
development when emerging skills become func- Levin et al., 1991), although increments are likely
tional. Therefore, an accurate understanding of to be minimal after 15 years of age (Hale, 1990;
normal cognitive development is critical for Kail, 1986).
health professionals working with children and
adolescents. This knowledge enables earlier iden- Cognitive Flexibility
tification of developmental deviations, improves In general, perseverative behavior is common in
diagnostic capabilities, and helps clinicians de- infancy, declines during early and middle child-
sign age appropriate treatment interventions. hood, and is rare in adolescence (Chelune & Baer,
Our current understanding of EF development 1986; Levin et al., 1991; Welsh et al., 1991). The
is based on a small number of developmental and capacity to switch rapidly between two simple
 ASSESSMENT AND DEVELOPMENT OF EF 77

response sets emerges between 3 and 4 years of identified on specific tasks, although these find-
age, but children in this age range have difficulty ings have not been consistently replicated in
switching when rules become more complex other studies. Areas in which girls have been
(Espy, 1997). Seven-year-olds struggle when reported to outperform boys include verbal
switching behavior is contingent on multiple fluency, information processing and spatial orga-
dimensions, however, the ability to cope with nization (Anderson, 2001; Anderson et al., 2000,
these multi-dimensional switching tasks improves 2001; Karapetsas & Vlachos, 1997; Levin et al.,
greatly between 7 and 9 years of age (Anderson 1991). In contrast, boys have performed better
et al., 2000). Switching fluency continues to than girls on a spatial reasoning/working memory
improve throughout middle childhood and into task (Krikorian & Bartok, 1998).
adolescence (Anderson et al., 2000). The capacity
to learn from mistakes and devise alternative Summary
strategies emerges in early childhood and devel- Research indicates that the executive domains
ops throughout middle childhood. mature at different rates. Integrating the findings
from developmental and normative studies, pro-
Goal Setting posed developmental trajectories for executive
Simple planning skills are exhibited by 4-year- domains are illustrated in Figure 2. These profiles
olds but younger children struggle to plan and are hypothetical approximations that require
organize actions in advance (Welsh et al., 1991). verification in future developmental studies.
Similarly, simple conceptual reasoning is too Processes within the attentional control domain
difficult for 3-year-olds, however, by 4 years of appear to undergo considerable development
age children are capable of generating new during infancy and early childhood, and by
concepts (Jacques & Zelazo, in press). Planning middle childhood self-control and self-regulation
and organizational skills develop rapidly between processes are relatively mature. Despite follow-
7 and 10 years of age (Anderson et al., 1996; ing slightly different developmental trajectories,
Krikorian & Bartok, 1998), and gradually there- information processing, cognitive flexibility, and
after into adolescence (Krikorian & Bartok, 1998; goal setting are all relatively mature by 12 years
Welsh et al., 1991). Young children utilize simple of age, although many executive processes are not
strategies which are usually inefficient, haphazard fully ‘‘established’’ until mid-adolescence or
or fragmented, but between 7 and 11 years of age early adulthood.
strategic behavior and reasoning abilities be- Developmental regressions have been reported
come more organized and efficient (Anderson, between 11 and 13 years of age, particularly in the
Anderson, & Garth, 2001; Levin et al., 1991; areas of self-regulation and strategic decision
Waber & Homes, 1985). Despite access to a making (Anderson et al., 1996, 2001). This
greater repertoire of strategies, regression from regression may be associated with a transitional
conceptual strategies to piecemeal strategies may period between developmental phases (Kirk,
occur around 12–13 years of age, suggesting a 1985), resulting in conflicts between developing
developmental period in which cautious and cognitive processes. For example, the implemen-
conservative strategies are preferred (Anderson tation of conceptual and ‘‘holistic’’ strategies
et al., 2001). Refinement of strategies and im- clashes with the execution of self-regulatory pro-
proved decision making continues during adoles- cesses, which requires close monitoring of per-
cence (Anderson et al., 2001; Levin et al., 1991). formance and prefers the ‘‘de-construction’’ of
tasks. Balancing and prioritizing these competing
Gender Differences demands requires ‘‘executive control’’, which
Most research to date indicates that boys and girls may only be possible when each executive
develop executive processes at a similar rate domain reaches a certain maturity level.
during childhood (Becker et al., 1987; Chelune & The protracted development of executive
Baer, 1986; Passler et al., 1985; Welsh et al., domains is likely to be aligned with neurophysio-
1991). Marginal gender differences have been logical changes, particularly synaptogenesis and
78 PETER ANDERSON

Fig. 2. Projected developmental trajectories of the executive domains.

myelination in the prefrontal cortex. Based on Future Directions

EEG data, five periods of rapid growth in the Conceptual models for psychological constructs
frontal lobes have been reported which reflect an such as EF provide the framework for devising
increase in the number and/or strength of frontal assessment protocols, the interpretation of test
lobe connections (Hudspeth & Pribram, 1990). performance and adaptive functioning, and the
The first growth spurt in the frontal lobe is from formulation of treatment and management strate-
birth to 5 years of age, consistent with significant gies. In order to confirm or modify existing EF
developmental gains in attentional control pro- models, large-scale exploratory and confirmatory
cesses. The other three executive domains (infor- factor analytic studies are required in the attempt
mation processing, cognitive flexibility, and goal to identify common executive factors and exam-
setting) exhibit rapid development between 7 and ine their inter-relationships.
9 years of age, which interestingly corresponds Executive functioning involves both cognitive
with the second growth spurt in the frontal lobe. and behavioral elements, however, at times cog-
The third growth spurt occurs between 11 and 13 nition and behavior are discordant. Dissociation
years, the period when all four executive do- between cognitive functioning and behavior/
mains approach maturity and ‘‘executive control’’ personality attributes may be due in part to the
emerges. In addition, it is clear that myelination roles of separate prefrontal systems. For example,
of prefrontal connections occurs gradually cognitive aspects of EF appear to be closely
throughout early childhood, middle childhood, linked with dorsolateral regions of the prefrontal
and adolescence (Giedd et al., 1996; Huttenlocher cortex, while behavioral manifestations of EDF
& Dabholkar, 1997; Klinberg, Vaidya, Gabrieli, are more closely aligned with orbital and ventral-
Moseley, & Hedehus, 1999). Progressive my- medial areas. Research is required to determine
elination is likely to result in more rapid the distinctions and overlap between the neuro-
and efficient transmission of nerves impulses, anatomical correlates of cognitive and behavioral
improved information processing, as well as aspects of EF.
enhanced integration of cognitive processes and Ecologically valid and developmentally appro-
improved executive control. priate measures are necessary. In the past, EF
 ASSESSMENT AND DEVELOPMENT OF EF 79

measures used with children have lacked ade- Anderson, P., Anderson, V., Northam, E., & Taylor, H.
quate validation and reliable normative data. (2000). Standardization of the Contingency Naming
Test for school-aged children: A new measure of
Greater selectivity in the tests administer to chil-
reactive flexibility. Clinical Neuropsychological
dren is required, ensuring that they are relevant, Assessment, 1, 247–273.
have undergone adequate standardization, and Anderson, S., Bechara, A., Damasio, H., Tranel, D.,
been validated in appropriate childhood condi- & Damasio, A. (1999). Impairment of social
tions. Given that most cognitive tasks require and moral behavior related to early damage in
executive processing to some extent, it may be human prefrontal cortex. Nature Neuroscience, 2,
more relevant to identify performance parameters 1032–1037.
Anderson, V. (1998). Assessment of executive function
that are associated with EF rather than labelling
in children. Neuropsychological Rehabilitation, 8,
specific measures as executive or non-executive. 319–350.
Finally, in order to enhance the diagnostic utility Anderson, V., Anderson, P., Northam, E., Jacobs, R.,
of EF measures, a micro-analytic approach to & Mickiewicz, O. (in press). Relationships between
assessment should be adopted incorporating cognitive and behavioral measures of executive
quantitative, qualitative and cognitive-process function in children with brain disease. Child
techniques. Neuropsychology.
Anderson, V., Anderson, P., Northam, E., Jacobs, R.,
Our understanding of EF development is pre-
& Catroppa, C. (2001). Development of executive
dominantly based on cross-sectional studies. functions through late childhood and adolescence in
Longitudinal designs are considered more valid an Australian sample. Developmental Neuropsy-
and reliable for assessing developmental changes, chology, 20, 385–406.
but such studies are rare as they are extremely Baker, S., Rogers, R., Owen, A., Frith, C., Dolan, R.,
costly, require many years of follow-up, and are Frackowiak, R., & Robbins, T. (1996). Neural
compromised by sample attrition and ‘‘learning systems engaged by planning: A PET study of
the Tower of London Task. Neuropsychologia, 34,
effects.’’ In the future, longitudinal studies will be
515–526.
required to verify our understanding of EF devel- Barrash, J., Tranel, D., & Anderson, S. (2000).
opment. With the assistance of structural and Acquired personality disturbances associated
functional neuroimaging, we are now in the posi- with bilateral damage to the ventromedial prefron-
tion to concurrently track the development of tal region. Developmental Neuropsychology, 18,
neural systems and cognitive functioning, greatly 355–381.
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