Susanne Phillips Keeley

Copyright © 2003 LinguiSystems, Inc.

Content Area: Executive Functions
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 About the Author

Susanne Phillips Keeley, M.S., CCC-SLP, earned

degrees in Communication Disorders & Speech
Science and Psychology from the University of
Colorado. She received her M.S. in Speech-Language
Pathology from Northwestern University and contin-
ues to work and live in the Chicago area.

She has specialized in the evaluation and treatment of

adult neurological disorders in many settings, includ-
ing inpatient acute care, outpatient, acute rehabilita-
tion, home care, and private practice.

The Source for Executive Function Disorders is

Susanne’s first publication with LinguiSystems.

Dedication

To my parents, Betty and Jim, for their love; to my friends the Bradley Family,
for their humor and encouragement and the Mates Family for their motivation
and insight; to my husband, Bill, for his love and support; and to my children,
Lauren and James, who make me smile every day.

The Source for Executive Function Disorders 2 Copyright © 2003 LinguiSystems, Inc.
 Table of Contents

Preface: Comments to Therapists....................................................................................7

Introduction: What Are Executive Functions?..............................................................9

Case Studies....................................................................................................................11

Assessment
Collecting the Patient History ......................................................................................13
Onset of Illness ...............................................................................................................14
Description of the Problem ............................................................................................16
Educational Background ...............................................................................................18
Employment and Schedule............................................................................................19
Past Medical History......................................................................................................20
Checklists and Observations.........................................................................................20
Materials/Forms:
Patient History .........................................................................................................21
Patient Comparison .................................................................................................25

Formal/Informal Assessment Tools.............................................................................27

Modifications in Presentation .......................................................................................28
Modifications in Scoring ................................................................................................29
Life Task Simulation......................................................................................................30
Checklists and Questionnaires .....................................................................................30
Materials/Forms:
Patient Checklist 1...................................................................................................31
Patient Checklist 2...................................................................................................32

Patient-Initiated Continuum (PIC) .............................................................................33

Methods ...........................................................................................................................33
Summary .........................................................................................................................34
PIC Examples .................................................................................................................35

Reports and Documentation..........................................................................................37

History .............................................................................................................................37
Subjective ........................................................................................................................38
Results .............................................................................................................................39
Interpretation..................................................................................................................40
Goals.................................................................................................................................41
Materials/Forms
Test Score Reporting................................................................................................43

The Source for Executive Function Disorders 3 Copyright © 2003 LinguiSystems, Inc.
 Table of Contents

Treatment
General Treatment Guidelines .....................................................................................45
Metacognitive Processes ................................................................................................45
Self-Assessment ..............................................................................................................47
Materials/Forms:
Performance Checklist.............................................................................................48

Time Management ............................................................................................................49

External System .............................................................................................................50
Materials/Forms:
Time Estimation Worksheet ...................................................................................72
Time Available Equation.........................................................................................73

Attention ..............................................................................................................................75
Focused Attention...........................................................................................................77
Sustained Attention .......................................................................................................78
Selective Attention .........................................................................................................82
Alternating Attention.....................................................................................................87
Divided Attention ...........................................................................................................92
Materials/Forms:
Required Attention Levels ......................................................................................98
Activity Worksheet...................................................................................................99
Cancellation Activities...........................................................................................100
Math Equations......................................................................................................116
Auditory Attention .................................................................................................122
Distractions Worksheet .........................................................................................133
Visual Selective Attention.....................................................................................134
Task Combination Worksheet ..............................................................................138
Alternating Attention Math..................................................................................139
Simultaneous Tasks Worksheet...........................................................................142
Divided Attention Activities..................................................................................143

Plan-Execute-Repair ......................................................................................................155
Materials/Forms:
Planning Form........................................................................................................166
Task Steps Activities .............................................................................................167
Task Sequencing Activities ...................................................................................171
Task Combination Activities.................................................................................172

The Source for Executive Function Disorders 4 Copyright © 2003 LinguiSystems, Inc.
 Table of Contents

Memory...............................................................................................................................173
Step 1 of Improving Memory.......................................................................................173
Step 2 of Improving Memory.......................................................................................175
Clinical Memory Tasks ................................................................................................178
Prospective Memory Tasks..........................................................................................179
Materials/Forms:
Memory Techniques...............................................................................................180
Memory Tasks ........................................................................................................181

Documentation ................................................................................................................185
Sample Treatment Sessions........................................................................................188

Answer Key ..........................................................................................................................198

The Source for Executive Function Disorders 5 Copyright © 2003 LinguiSystems, Inc.
 Preface

Comments to Therapists

T he increasing prevalence of brain damage as a result of head

trauma, stroke, or a tumor has resulted in a need for thera-
pists skilled in the evaluation and treatment of this population.
Materials developed for language-impaired individuals have not
always been appropriate, and consequently, there has been an
increase in the amount of commercially-available material target-
ing the brain-injured adult population. Most of these treatment
manuals contain activities appropriate for levels of severity that
range from mild to severe. Frequently, high-level assessments and
treatment activities are mixed with lower-level tasks within the
text. Often, they do not provide the comprehensive consideration
the executive function disordered population requires. Using tasks
designed for low-level patients and increasing the linguistic/atten-
tion/memory parameters of the task alone is not sufficient.
Activities related to the patient’s life and what the patient finds
interesting are most likely to be effective. However, it is difficult to
find specific task-training activities at the high level that could
engage a patient for more than a few minutes, and certainly not an
entire treatment course.

Because this book is devoted to rehabilitation practice, it assumes

basic knowledge of neuroanatomy, neurophysiology, neurological
disease/impairment, and the mechanisms of brain injury. It con-
tains activities for both the therapist and the patient. It is based
on the premise that the patient is the best interpreter of his or her
particular impairment. It is the therapist’s responsibility to ask
the right questions in order to obtain this information, substantiate
the complaint with evaluation tools, design treatment activities

The Source for Executive Function Disorders 7 Copyright © 2003 LinguiSystems, Inc.
 Comments to Therapists

that address the deficit areas, and monitor progress. This manual provides a
structured framework for therapists to guide the processes of evaluation and
treatment of patients with executive function disorders.

Results of studies have illustrated the improvement of cognitive functioning via

theoretically-based rehabilitation exercises that methodically target specific
processes. The Source for Executive Function Disorders contains contrived, high-
ly clinical activities systematically targeting specific processes. It goes the extra
step, however, to assist the therapist in applying therapeutic remediation to
activities in the patient’s daily life. Of utmost importance is the therapist’s abil-
ity to think and analyze. This manual will instruct the therapist in determining
which areas and activities are appropriate for each individual client, the struc-
tured and systematic presentation of treatment stimuli, and important compo-
nents of documentation.

Because of the high level of the activities necessary to treat patients with execu-
tive function disorders, the therapist must possess a certain level of skill with his
or her own executive functions. For example, the therapist will be required to
break down tasks into their component parts, train in methods of prioritization,
and participate in difficult alternating and divided attention tasks. Just as not
every speech-language pathologist has the “ear” to be a good voice therapist, with-
out extra work and effort, not every therapist will fall into executive function
treatment easily. Work through the activities in this manual yourself. Try them
with your friends and family, and begin to develop a feeling for the wide range
of normal.

The Source for Executive Function Disorders 8 Copyright © 2003 LinguiSystems, Inc.
 Introduction Executive functions perform as a collective service that
comes into play with all facets of cognitive processing.

What Are Executive Functions?

A s one advances hierarchically through the animal chain, a larg-

er portion of the brain’s cortex is devoted to the frontal struc-
tures. This region of the brain is the most modern in evolutionary
development, and it is the last to develop and mature in an individual.

The frontal lobes of the brain are marked by their neuroanatomic diver-
sity. The frontal lobes have numerous connections to other sections of
the brain, and the functions they carry out are the product of informa-
tion collected from many locations in the central nervous system.

The frontal lobes are not only accountable for primary cognitive func-
tions but also for coordinating and actualizing the activities involved in
cognitive processing. The frontal lobes coordinate input from other sec-
tions of the brain, and they function to organize and regulate behavior
necessary to reach accomplishment of certain tasks. The frontal lobes
are fundamental to the executive functions of anticipation, goal selec-
tion, planning, self-monitoring, use of feedback, and completion of pur-
poseful activities.

The anatomical positioning of the frontal lobes leaves them sensitive

to injury. They rest against rough, bony protuberances of the inner,
anterior skull and, as the result of head injury, are easily scratched or
bruised. Damage to the frontal lobes results in a combination of behav-
ioral and emotional deficits and cognitive problems—specifically,
decreased executive functions.

The Source for Executive Function Disorders 9 Copyright © 2003 LinguiSystems, Inc.
 What are Executive Functions?

Executive functions do not portray a single, distinct process. Instead, executive func-
tions perform as a collective service that comes into play with all facets of cognitive
processing. Executive functions are a collage of cognitive activities that encompass
the ability to design actions toward a goal, to handle information flexibly, to realize
the ramifications of behavior, and to make reasonable inferences based upon limited
information. Additionally, executive functions can be thought of as encompassing
such activities as anticipation, goal selection, planning, initiation of activity, self-reg-
ulation or self-monitoring, and use of feedback. The executive functions are detailed
functions of logic, strategy, planning, problem solving, and reasoning.

Impairment of any or all of these executive functions may be present in spite of strong
intellectual skills and unaffected language capacity. When executive functions are
impaired, all other cognitive systems have the potential to be affected, even though
those same systems may remain undiminished in isolation. Individuals with execu-
tive function impairments have difficulty with planning and organization. They are
unable to identify what needs to be done and/or are unsure of how to accomplish the

parietal lobe frontal lobe

LifeART image Copyright © 2003 Lippincott & Wilkins. All rights reserved.

occipital lobe temporal lobe

Lobes of the brain

The Source for Executive Function Disorders 10 Copyright © 2003 LinguiSystems, Inc.
 What are Executive Functions?

steps to completion in an orderly way. Individuals often appear inattentive and dis-
organized. Frequently, they miss deadlines, are late for appointments, or oversched-
ule themselves. People with executive function impairments demonstrate difficulties
with initiation as well as experience pitfalls in beginning tasks. This may be evident
by the person sitting idle when directly asked to do something, or in a more subtle
form, by someone appearing less spontaneous or less energetic than might otherwise
be expected. Once the person begins a task, he or she may have problems maintain-
ing attention to the task or in persisting to the end. With executive function impair-
ments, self-monitoring and self-regulation become arduous. People with executive
function disorders are inconsistent in their performance and have problems integrat-
ing feedback or suggestions.

Executive function disorders are characterized by the following:

➤ difficulty with planning and organization
➤ trouble identifying what needs to be done
➤ problems determining the sequence of accomplishment
➤ difficulty carrying out the steps in an orderly way
➤ difficulty beginning tasks
➤ problems maintaining attention
➤ trouble evaluating how they are doing on a task
➤ difficulty taking feedback or suggestions

Case Studies
1. KB is a 35-year-old male who was injured when a ceiling fell on him.
He reportedly lost consciousness for a short period of time (5-10 minutes) and
was taken to the emergency room. He was treated and released. Since that
time, he reported being unable to work and experienced a variety of physical,
cognitive, and emotional difficulties. He reported difficulties with attention,
organization of thought in both speaking and writing information, and poor
time management. KB earned a B.A. degree from a large university and, at
the time of his accident, owned a special events planning business. At the time
of his injury, he had several events mid-project, which he completed, but per
his and his clients’ reports, at a substandard level. Since completing these proj-
ects, he has been unable to accept new projects or solicit new clients stating, “I
know I should, but I just can’t seem to do it.”

2. LE is a 33-year-old female who was in a car accident. She reported loss

of consciousness for a “few minutes.” She noticed a decline in her memory since
the accident, but she attributed this to medication she was taking for the back

The Source for Executive Function Disorders 11 Copyright © 2003 LinguiSystems, Inc.
 What are Executive Functions?

pain she developed from the accident. The changes in memory persisted even
after she discontinued use of the medication. At the time of the accident, LE
was enrolled in the last quarter of an M.B.A. program in finance and interna-
tional business, earning A grades. She completed her last quarter, earning C
grades and feeling she “learned very little.” LE has been unable to look for a job
since completing her degree. She says that she “reads the paper and doesn’t see
any jobs” appropriate for her. She has not developed a resumé nor enlisted the
help of her college placement department. She has moved back home with her
parents.

3. JW is a 48-year-old male diagnosed with a left frontal lobe brain

tumor. The tumor was resected and found to be benign. No chemotherapy or
radiation was indicated. JW described struggling to keep up the responsibili-
ties of his job as a director at an advertising agency. He reported daydreaming
during meetings, missing important meetings even though he had thought
about them earlier in the day, and being unable to do more than one thing at
a time.

4. PS is a 42-year-old male who was in his usual state of good health

when he fell off his bike and lost consciousness. A CT scan identified a
skull fracture on the left with blood present in the right frontal area. Since the
accident, he noted decreased concentration, short-term memory difficulties,
and organizational problems. He is a self-employed manufacturer’s represen-
tative and a single father of four children ages 7-18 who live with him. PS’s
major complaints revolved around home activities as opposed to work. He
reported frequently failing to finish the laundry and finding wet clothes days
later in the machine. He was often late for scheduled pick-ups of his children
and reported feeling very irritable when helping with homework, a task he pre-
viously enjoyed doing.

The Source for Executive Function Disorders 12 Copyright © 2003 LinguiSystems, Inc.
 Assessment

Collecting the Patient History

T he collection of information during the history section of the

evaluation is an essential aspect of the assessment. By care-
fully questioning the patient and even more carefully listening to his or
her answers, you can determine the areas to be assessed and treated.
The patient history is not merely an opportunity to fill in the blanks
on a form; instead, it is an opportunity to truly learn how the patient
arrived at this point and how he or she hopes to be helped. Using the
standard Patient History form on pages 21-24 allows the adminis-
trator to concentrate on the patient’s answers and descriptions rather
than formulating what question to ask next.

Helpful Hint: Fill out the history form while proceed-

ing through the session. When appro-
priate, tape record or videotape the
session to further allow for the
opportunity to listen and respond.

The Source for Executive Function Disorders 13 Copyright © 2003 LinguiSystems, Inc.
 Collecting the Patient History

1/4 Patient History

Name: Medical Record Number:

Address: ________________________________________ DOB/Age:

________________________________________
________________________________________ Referring M.D.:

Onset of Illness Phone: Date:

Collect the general demographic information and any Onset of Illness

facility-specific information. Begin by asking the (Circle one) Head Injury CVA Brain Tumor Other _______________________

patient to describe the injury/event in detail. Date of onset: ______________________________________________________________________

Describe event in detail: ________________________________________________________________
______________________________________________________________________
______________________________________________________________________

If this was an accident: ______________________________________________________________________

Have you had a CT/MRI? Yes No

➤ Did the patient lose consciousness? If so, for how What were the findings? _________________________________________________________________
______________________________________________________________________

long? If not, did the patient feel “dazed”? How long ______________________________________________________________________
______________________________________________________________________

did that feeling last? At what point did the patient Have you had any medical interventions for this injury?
Explain:
Yes No
______________________________________________________________________

begin to recall what was happening?

______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
➤ Can the patient remember the events leading up to What medications are you currently taking?______________________________________________

the accident? What about those after?

______________________________________________________________________
______________________________________________________________________

➤ Did a physician treat the patient? Was the patient

When was your last complete physical? _________________________________________________
What were the findings? ________________________________________________________________

hospitalized? For how long? ______________________________________________________________________

______________________________________________________________________

➤ Was a CT/MRI performed? If so, what were the

______________________________________________________________________
Have you had a psychological screening? Yes No

results? What were the findings? ________________________________________________________________

______________________________________________________________________

➤ Did the patient sustain any other injuries? ______________________________________________________________________

If this was a brain tumor:

➤ What symptoms led the patient to see a doctor in the first place?
➤ When was the patient diagnosed?
➤ Where was/is the tumor located? Does the patient know the type of the tumor?
➤ Did the patient have the tumor removed surgically?
➤ Has the patient had any radiation or chemotherapy?
➤ How have the symptoms changed during the course of medical treatment? Have
any new symptoms appeared?
➤ Is the patient having routine CT/MRI scans? How often?

If this was a stroke:

➤ Did the patient have any symptoms prior to the stroke?
➤ What were the symptoms of the stroke?
➤ For how long did the stroke symptoms persist?
➤ Does the patient know what type of stroke it was or where it occurred in
the brain?
➤ Is the patient receiving follow-up medical care since the stroke?

After gaining a clear understanding of the cause of the brain injury and medical
intervention, obtain information regarding the patient’s current medications. A
number of drugs are implicated as causes of changed cognition. These include, but
are not limited to, the medications listed on the following page.

The Source for Executive Function Disorders 14 Copyright © 2003 LinguiSystems, Inc.
 Collecting the Patient History

➤ sedatives ➤ narcotics
➤ anticonvulsants ➤ antidepressants
➤ antihypertensive drugs ➤ anti-Parkinsonian drugs
➤ H2 receptor antagonists ➤ phenylthiazines
➤ corticosteroids

Helpful Hint: It is important to have a current During this phase of the examination, you
Physician’s Desk Reference handy. should also ask the patient for details regard-
Call the patient’s physician if you are ing alcohol consumption, drug abuse, over-the-
unsure of a particular drug’s possible counter medications, and vitamins or herbal
affect on cognition. supplements.

When was the patient’s last complete physical? Despite being under a doctor’s care
for the brain injury, a general physical may not have been conducted. A variety of
medical conditions can cause alterations in mental status and cognitive abilities.
These include, but are not limited to, the following:
➤ hypertension ➤ hypotension
➤ cardiac illness ➤ severe anemia
➤ vitamin B12 deficiency ➤ sickle cell disease
➤ leukemias ➤ liver disorders
➤ uremia ➤ hyper/hyponatremia
➤ hypercalcemia ➤ hyperparathyroidism
➤ gypomagnesemia ➤ thyroid disorders
➤ diabetes mellitus ➤ nutritional disorders
➤ infectious diseases including Lyme disease and HIV infection

It is important that a medical physician be involved to rule out any medical condi-
tions responsible for changed cognition. Refer the patient to his or her physician if
he or she has not received a complete physical.

Of equal importance is the patient’s psychological health. Brain injury, and specifi-
cally frontal lobe injury, can cause behavioral and emotional changes. Determine
whether a psychological screening has been conducted to rule out anxiety, depres-
sion, or other psychological diagnoses that may be responsible or contributing to the
changed condition. Refer the patient to a neuropsychologist or back to his or her
physician if this has not been conducted.

The Source for Executive Function Disorders 15 Copyright © 2003 LinguiSystems, Inc.
 Collecting the Patient History

2/4 Patient History Patient: _________________________

Description of the Problem

As completely as possible, describe what you have difficulty with: ________________________

______________________________________________________________________
______________________________________________________________________
Description of the Problem ______________________________________________________________________
______________________________________________________________________

At this point in the interview, focus turns to the What do you do to compensate for these difficulties? ____________________________________
______________________________________________________________________

patient’s complaint. What exactly does the patient find

______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
difficult or changed from his or her usual status? Do any of these compensations help? Yes No

Patients know clearly what is challenging for them but Explain: ______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
do not always provide good descriptions. Most will ______________________________________________________________________

require prompts to be more specific and to generate Have these problems become better or worse over time? ________________________________
Explain: ______________________________________________________________________

examples. It is the therapist’s responsibility to narrow ______________________________________________________________________

______________________________________________________________________

and clarify the scope of the patient’s complaint. For

______________________________________________________________________

example, if the patient states, “I can’t remember any-

Educational Background
thing!” the therapist follows with questions and cues Number of years of education, degree(s) earned, etc.: ___________________________________
such as those listed below and on the following pages to ______________________________________________________________________
______________________________________________________________________

define this more distinctly. ______________________________________________________________________

When you were in school, did you find it easier to learn by hearing or reading the informa-
tion? Has that changed? How? __________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

Patient Comment Clinician Follow-Up

I can’t remember anything. Give me an example of something you recently
failed to remember.
Do you have more trouble recalling information
that you hear or that you read?
Do you have more difficulty remembering
“important” information or more casual, con-
versational information?
Can you remember what you did yesterday?
Can you remember what you are supposed to do
this weekend?
When you forget something, do you eventually
remember or must you be reminded?
Are there particular things you always have dif-
ficulty remembering?

I have trouble getting anything done. Are you able to identify what tasks you want or
need to accomplish?
Do you have more difficulty completing simple
daily tasks or long-term projects?
Is it easy to generate the steps involved in com-
pleting the activity?

The Source for Executive Function Disorders 16 Copyright © 2003 LinguiSystems, Inc.
 Collecting the Patient History

Patient Comment Clinician Follow-Up

Do you have trouble getting started?
Are you easily drawn off task?
Do you frequently feel overwhelmed with what
needs to be accomplished?

I can’t pay attention to anything. Can you focus on something you are really
interested in for 5-10 minutes? At what length
of time do you lose attention in this interesting
task?
Can you concentrate in the midst of distractions?
Can you do two things at one time?
Do you “space out” and daydream or move on to
another task? How long will this last?
Are you aware of when you lose attention?

I’m always late. Are you aware of when an event is scheduled?

Are you conscious of the time during the day?
Do you know how long it will take you to do
something or get somewhere? What makes you
late?

Does the patient utilize any compensatory

Helpful Hint: Asking the patient to provide exam- strategies? What are these strategies and how
ples can be very helpful in under- successful are they? Pose questions (such as the
standing the patient’s complaint. following) to the patient in order to understand
strategies and compensations being used.
➤ Does the patient use a calendar?
➤ Does the calendar have hour by hour slots, or is it for the whole day?
➤ How often does the patient look at the calendar?
➤ How consistent is the patient in writing in the calendar?
➤ Has the patient always used a calendar? Has the method of usage changed?
Has the success with the calendar changed?
➤ Does the patient wear a watch? Always or recently?
➤ Does the patient keep lists? Is this a new behavior? If not, has the method
changed?
➤ Does the patient turn off the TV or radio before starting to do something? Is this
a new pattern?
➤ Does the patient limit activities to one at a time? Is this something new?
➤ Does the patient complete one task before moving on to the next?

The Source for Executive Function Disorders 17 Copyright © 2003 LinguiSystems, Inc.
 Collecting the Patient History

Lastly, has the patient noted change in the deficits over time? Most patients will feel
the problem has become worse. Perhaps it has, or perhaps the farther from “usual”
the patient goes, the greater the frustration and feeling of decline. Again, the thera-
pist’s ability to clarify the issue is key.

Patient Comment Clinician Follow-Up

I didn’t have any problems right Did you return to work/school? Did you main-
after the injury. tain your previous schedule?
Did you maintain your previous responsibili-
ties?

I was doing fine for a while. Did you receive regular feedback from your
supervisor, friends, or family?
Were you receiving assistance from others at
home/work?
Do you feel you are expected to perform at “pre-
injury” levels at this point?

I wasn’t this tired before. Were you keeping the same schedule as now?
Are your medications the same?
Were your responsibilities of the same level of
difficulty as now?

Educational Background
Take the following questions into consideration when completing this section:
➤ How much schooling has the patient completed? Lower levels of education do not
negate the existence of high-level deficits. Adults are required to be proficient in
a large variety of attention, memory, and language skills, regardless of edu-
cational levels achieved; however, patients earning advanced degrees in mathe-
matics should find no difficulty balancing a checkbook. Knowing the patient’s
premorbid level of education allows for assumptions about premorbid abilities.
➤ What subjects/topics were challenging for the patient in school? Have these
areas continued to be challenging even outside the school setting? Everyone has
strengths and weaknesses. Being aware of the patient’s perceived areas of
weakness assists in making realistic estimates of impairments.
➤ What was the patient’s learning style during school? How did the patient learn
and recall information while in school? Was the patient an auditory learner—
able to recall the lectures more easily than the textbook—or vice versa? Does the
patient feel this pattern of learning has continued? Does the patient feel this

The Source for Executive Function Disorders 18 Copyright © 2003 LinguiSystems, Inc.
 Collecting the Patient History

Patient: _________________________ Patient History 3/4

pattern of learning has changed Employment and Schedule

as a result of the brain injury? Outside the Home
Emphasize the preferred learning Job:
Company:
______________________________________________________________________
______________________________________________________________________
style during therapy whenever How long in this position? _______________________________________________________________
Chief Responsibilities: ___________________________________________________________________

possible. ______________________________________________________________________
______________________________________________________________________
Describe a typical day prior to your injury: _______________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Describe a typical day now: ____________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

Employment and Schedule Has your ability to perform your job changed in any fashion?
Explain:
Yes No
______________________________________________________________________

At this point in the history collection, ______________________________________________________________________

define the patient’s work and home Within the Home

Do you have children? Yes No How Many? __________
regimens. Ask the patient to describe, Ages/Genders ______________________________________________________________________
______________________________________________________________________

in detail, his or her work prior to the Describe a typical day prior to your injury: _______________________________________________
______________________________________________________________________
injury. The word work is intended in ______________________________________________________________________
______________________________________________________________________

its broadest form: it is not limited to Describe a typical day now: ____________________________________________________________
______________________________________________________________________
outside the home/office work. Women ______________________________________________________________________
______________________________________________________________________
or men working in the home should Has your ability to perform your duties changed in any fashion? Yes No

proceed through the same descriptions Explain: ______________________________________________________________________

______________________________________________________________________

and questioning. Ask the patient to

portray a typical day. Ascertain the
following from the patient:
➤ the time schedule of events/tasks
➤ the amount of tasks required in a day
➤ the type of tasks
➤ the dependence/independence upon others for completing the tasks
➤ the people available for assistance
➤ the number of people/number of tasks for which others depend upon the patient
➤ the physical surroundings (quiet or noisy, in an office or cubical, or in the open)
➤ whether the patient is in one location for the duration of the day or is required
to move about
➤ the number and type of distractions and interruptions in the day
➤ whether each day is the same

Understanding the expectations of a “normal day” is fundamental to restoring the

patient’s routine.

Complete the same line of questioning for a

Helpful Hint: This task may also be used as a typical day since the injury. The therapist
homework assignment encompassing can complete the Patient Comparison
written expression. chart on page 25 for pre- and post-injury to
more easily see the variations.

The Source for Executive Function Disorders 19 Copyright © 2003 LinguiSystems, Inc.
 Collecting the Patient History

Once treatment begins, the therapist’s responsibility will be to analyze tasks the
patient finds difficult and develop compensations/restoration techniques for these
tasks. The more complete the therapist’s understanding of the patient’s life situation
pre- and post-injury, the better the therapist will be in developing appropriate inter-
vention tasks.

Past Medical History 4/4 Patient History Patient: _________________________

Obtain past medical history information. Specifically, Past Medical History

ask whether the patient has ever had previous head or Have you had other accidents/injuries/illnesses? Yes No

brain injuries. This includes concussion, which the Explain: ______________________________________________________________________

______________________________________________________________________

patient will likely not consider a head injury.

______________________________________________________________________

Are there any medications you formerly took but are not taking now? Yes No

Remember that brain injury is cumulative: the current Explain: ______________________________________________________________________

______________________________________________________________________

injury may be compounded by previous minor inci- ______________________________________________________________________

dences. Ask the patient about previous medications and Checklist of Behaviors
the reason for their discontinuance. Perhaps the WNL* Deviant

patient had a medical issue prior to the injury that may Sustained Attention
Selective Attention

impact cognition and/or recovery. Determine whether

Alternating/Divided Attention
Long-Term Memory
Short-Term Memory

there is or has been alcohol or substance abuse. Also, Prospective Memory

Active Orientation to Time

rule out or define previously diagnosed attention deficit Place

Person

disorder or learning disabilities. Ask whether the

Time Tracking/Sequencing
Comprehension of General Conversation
Organization of Thought
patient has any prior diagnosis/treatment for anxiety, Word Retrieval
Repetition of Ideas

depression, panic attacks, or other psychological diag- Clarity of Expression

Completeness

noses. Insure that the appropriate professionals are Facial Expression

Verbal Intonation

involved in treatment.
Gestures
Proxemics
Use of Humor
Topic Maintenance
Turn Taking
Presupposition
Error Awareness
Self-Correction
*Within Normal Limits

Checklists and Observations

In addition to obtaining facts during this initial discussion, you can collect informa-
tion regarding the patient’s ability to recall information, orient events in time, com-
prehend questions, express thoughts, comprehend and use nonverbal cues, and use
pragmatics. Use the checklist as a cursory record of subjective observations.
Deviancies will point toward areas requiring formal assessment.

The Source for Executive Function Disorders 20 Copyright © 2003 LinguiSystems, Inc.
 1/4 Patient History

Name: Medical Record Number:

Address: ________________________________________ DOB/Age:

________________________________________
________________________________________ Referring M.D.:

Phone: Date:

Onset of Illness

(Circle one) Head Injury CVA Brain Tumor Other _______________________

Date of onset: ______________________________________________________________________

Describe event in detail: ________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Have you had a CT/MRI? Yes No
What were the findings? _________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Have you had any medical interventions for this injury? Yes No
Explain: ______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
What medications are you currently taking?______________________________________________
______________________________________________________________________
______________________________________________________________________
When was your last complete physical? _________________________________________________
What were the findings? ________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Have you had a psychological screening? Yes No
What were the findings? ________________________________________________________________
______________________________________________________________________
______________________________________________________________________

The Source for Executive Function Disorders 21 Copyright © 2003 LinguiSystems, Inc.
 2/4 Patient History Patient: _________________________

Description of the Problem

As completely as possible, describe what you have difficulty with: ________________________

______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
What do you do to compensate for these difficulties? ____________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Do any of these compensations help? Yes No
Explain: ______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

Have these problems become better or worse over time? ________________________________

Explain: ______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

Educational Background

Number of years of education, degree(s) earned, etc.: ___________________________________

______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
When you were in school, did you find it easier to learn by hearing or reading the informa-
tion? Has that changed? How? __________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

The Source for Executive Function Disorders 22 Copyright © 2003 LinguiSystems, Inc.
Patient: _________________________ Patient History 3/4

Employment and Schedule

Outside the Home

Job: ______________________________________________________________________
Company: ______________________________________________________________________
How long in this position? _______________________________________________________________
Chief Responsibilities: ___________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Describe a typical day prior to your injury: _______________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Describe a typical day now: ____________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Has your ability to perform your job changed in any fashion? Yes No
Explain: ______________________________________________________________________
______________________________________________________________________

Within the Home

Do you have children? Yes No How Many? __________
Ages/Genders ______________________________________________________________________
______________________________________________________________________
Describe a typical day prior to your injury: _______________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Describe a typical day now: ____________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Has your ability to perform your duties changed in any fashion? Yes No
Explain: ______________________________________________________________________
______________________________________________________________________

The Source for Executive Function Disorders 23 Copyright © 2003 LinguiSystems, Inc.
 4/4 Patient History Patient: _________________________

Past Medical History

Have you had other accidents/injuries/illnesses? Yes No
Explain: ______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

Are there any medications you formerly took but are not taking now? Yes No
Explain: ______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

Checklist of Behaviors

WNL* Deviant
Sustained Attention
Selective Attention
Alternating/Divided Attention
Long-Term Memory
Short-Term Memory
Prospective Memory
Active Orientation to Time
Place
Person
Time Tracking/Sequencing
Comprehension of General Conversation
Organization of Thought
Word Retrieval
Repetition of Ideas
Clarity of Expression
Completeness
Facial Expression
Verbal Intonation
Gestures
Proxemics
Use of Humor
Topic Maintenance
Turn Taking
Presupposition
Error Awareness
Self-Correction
*Within Normal Limits

The Source for Executive Function Disorders 24 Copyright © 2003 LinguiSystems, Inc.
 Patient Comparison

Name: Medical Record Number:

Address: ________________________________________ DOB/Age:

________________________________________
________________________________________ Referring M.D.:

Phone: Date:

Pre-Injury Post-Injury
Daily time schedule:
➤ waking
➤ sleeping
➤ naps
➤ appointments

Amount of tasks required in

a day
➤ type of tasks

Dependence/independence
upon others for completing
the tasks

People available for

assistance

Number of people/number
of tasks for which others
depend upon the patient

Physical surroundings; quiet

or noisy, in an office or
cubical, or in the open

In one place for the duration

of the day or required to
move about

Number and type of interrup-

tions that occur in the day

Is each day the same?

The Source for Executive Function Disorders 25 Copyright © 2003 LinguiSystems, Inc.
 Assessment

Formal/Informal Assessment Tools

O nce you’ve obtained the patient’s history and description of the

problem, evaluate these complaints, determine their severity,
and compare against expected levels of performance. Standardized
assessment instruments provide information about performance
under controlled conditions. The patient’s performance is compared to
normative data on others with similar age and/or education. There
are a variety of commercially-available, formal assessment procedures
specifically designed for brain injury. Areas that are important to
assess include:
➤ orientation
➤ attention
➤ short-term memory
➤ long-term memory
➤ prospective memory
➤ new learning
➤ word retrieval
➤ reading comprehension
➤ reading speed
➤ written content and organization
➤ mathematical accuracy and speed
➤ convergent reasoning
➤ divergent reasoning
➤ inductive reasoning
➤ deductive reasoning
➤ problem solving
➤ sequencing
➤ mental flexibility

The Source for Executive Function Disorders 27 Copyright © 2003 LinguiSystems, Inc.
 Formal/Informal Assessment Tools

Whenever a formal, normative test demonstrates the described deficit, it is the superior
method of evaluation. Frequently however, neither the executive function deficit nor the
severity of the deficit are highlighted via standardized instruments. Traditional stan-
dardized tests do not mirror the true demands that are made in everyday life. Adequate
performance on a standardized test does not rule out executive function disorders.
Instead, adjunctive modifications to the test or entirely new assessment methods must
be utilized.

Non-standardized tasks provide a more functional picture of performance and offer a

reflection of the patient’s performance in real-life tasks. Non-standardized assessment
allows for examining performance in different contexts and situations, which is a crucial
component in executive functioning. There are several modifications to standardized
tests that more effectively tap into executive functions. Formal assessment measures
are carefully designed, and altering the stated design of the test negates the normative
information. The patient can no longer be compared to other patients but can, never-
theless, be compared to himself or herself in a pre- and post-test fashion. There are sev-
eral modifications to a standardized instrument or subtest that are beneficial in execu-
tive function assessment.

Modifications in Presentation
➤ Order of Presentation: Frequently, tests are structured in a hierarchical fashion with
the most difficult items at the end of the test. When these later occurring items are in
error, it is hard to determine whether the difficulty of the item was the key deterrent
or whether it was the late presentation of the item challenging sustained attention. By
presenting more difficult items first and proceeding to easier items, this question can
be answered and assumptions made regarding sustained attention skills.
Another variation of presentation is to be truly random. Often patients “tune in” to
a greater extent when they perceive tasks as difficult. Alternating between the
more simple and more complex will eliminate the opportunity to establish a pattern
of response.
➤ Staged Interruptions: To determine how the patient responds to interruptions,
schedule a phone call, page, or door knock during the testing. Is the patient able to
return easily to the task or does the patient require some time to “regroup”? The
patient’s response to the situation can provide information about alternating atten-
tion and the ability to start and stop tasks.
➤ Distractions: Most testing situations are ideal—a quiet, well-lit, well-heated/cooled
clinical room. This is not how most life situations occur. Administer the assessment
in a noisy environment with distracting activities surrounding the task. By doing
this, you can judge the patient’s selective attention (how easily the patient can tune
out distractions and concentrate on the work at hand). Administer the same assess-
ment or variation in a quiet testing environment for comparison.

The Source for Executive Function Disorders 28 Copyright © 2003 LinguiSystems, Inc.
 Formal/Informal Assessment Tools

➤ Dual Assessment: If the patient describes difficulty doing more than one thing at
a time, mimic this in the assessment. Can the patient alternate between two
subtests and maintain the same degree of accuracy as with a single task? Is the
patient more able to alternate between two reading tasks vs. between a reading
and a math task?
➤ Time Constraints: The perception of being hurried can impact performance.
Telling the patient that there is a limited time to complete the task can impact
performance. The actual imposition of these time constraints is optional.
➤ Mix It Up: Combine the above modifications. How does performance compare
when the patient has less time to respond and is faced with distractions?

Modifications in Scoring
Standardized scoring methods of a formal assessment tool are only one method of
determining performance. Other variables of the patient’s performance should be
considered and quantified. (When you’ve made modifications to the prescribed
administration of the test you must modify scoring.)
➤ Accuracy: Most testing sections can be scored as number right vs. number
wrong. This can be transformed into a percentage score.
➤ Speed: Timing how long a particular section, or the entire test, takes to complete
can highlight those patients who have extended processing time. Conversely,
some patients may complete tasks at a very quick pace. Compare how the
patient’s speed of performance changes relative to the modifications in presen-
tation described previously.
➤ Completeness: With what degree of thoroughness did the patient complete the
task? Deficits may be noted in skipping items, omitting details, and/or failing to
complete the task. Document the percentage of items falling into these situa-
tions. On the other end of the spectrum, patients who have difficulty monitor-
ing their output and ending tasks may generate far more than is necessary.
➤ Efficiency: Never set up an evaluation task and turn away. Note how the
patient completes the task. Is it done in a logical, proficient manner, or is it
attempted haphazardly? Document the method the patient uses to complete the
task. Compare how the patient’s efficiency varies relative to the modifications
in presentation previously described.
➤ Error Awareness: Note if the patient spontaneously reviews his or her work or
comments on errors during the testing. Allow the patient to “self-grade” the
work. Can the patient identify errors? Document the percentage of errors the
patient is able to identify independently and when given cues. Compare the
patient’s ability to identify errors when modifications in presentation are made.
➤ Self-correction: If error awareness is present, determine if the patient can
expand this to correction. Is the patient able to correct spontaneously or are cues

The Source for Executive Function Disorders 29 Copyright © 2003 LinguiSystems, Inc.
 Formal/Informal Assessment Tools

required? If you identify errors for the patient, can he or she correct them inde-
pendently? Document the percentage of identified errors that the patient can
self-correct. Compare the patient’s ability to correct errors when modifications
in presentation are made.

Life Task Simulation

Manipulating the methods of presentation and scoring of standardized evaluation
tools is one method of evaluation. Additionally, observing the patient participating
in tasks described as difficult is a beneficial evaluation tool.

Having determined a typical pre-injury day for the patient during the Patient
History section of the evaluation, usual tasks for the patient have been identified.
Simulate one of these tasks and quantify the patient’s performance in terms of the
modifications in scoring described previously. For example:
➤ Generate a typed memo regarding a hypothetical situation.
➤ Complete a form or check while requesting a phone number from information.
➤ Read a newspaper article with the radio on.
➤ Scan the TV schedule while talking on the phone.
➤ Complete a time card.
➤ Develop a shopping list from a specific recipe.
➤ Find the least expensive airfare from a newspaper ad, Internet service, or phone
call.
➤ Sort 25 children into carpools for a hypothetical field trip.

Checklists and Questionnaires

Checklists and questionnaires are excellent tools to clarify patients’ difficulties. They
can also serve to quantify subjective complaints. A number can be assigned to each
level of response. The scale below is used to complete the checklists on pages 31 and
32:
➤ Almost always = 5
➤ Usually = 4
➤ Sometimes = 3
➤ Seldom = 2
➤ Almost never = 1
This technique permits a numerical score to be attached to an item or group of items.
Changes in the patient’s rating as treatment commences can be reported as changes
in score.

The Source for Executive Function Disorders 30 Copyright © 2003 LinguiSystems, Inc.
 Patient Checklist 1

Name: Medical Record Number:

Address: ________________________________________ DOB/Age:

________________________________________
________________________________________ Referring M.D.:

Phone: Date:

almost almost
always usually sometimes seldom never

5 4 3 2 1
I find it easy to determine my 2-3 priority tasks for
the day.
I find it easy to schedule my 2-3 important tasks for
the day.
I find it easy to know the steps involved in
completing my 2-3 tasks.
I accomplish my 2-3 tasks daily.
I am efficient in completing tasks.
I complete tasks by their deadline.
I find it easy to get started on tasks and don’t
procrastinate.
I find it easy to stop working on a task when it is
time to do something else.
I am not easily distracted from the activity at hand.
I work on my difficult tasks when my energy is at
its peak.
Tasks typically take the amount of time I expect.
I am able to modify my schedule when things don’t
go as planned.
I don’t delay difficult tasks.
I never forget an appointment.
I am on time and prepared for engagements.
I return calls when I say I will.
I complete projects in an organized fashion.
I can see different ways to complete a task.
I feel like I have enough mental energy during
the day.
My daily activities reflect and support my overall
goal.

The Source for Executive Function Disorders 31 Copyright © 2003 LinguiSystems, Inc.
 Patient Checklist 2

Name: Medical Record Number:

Address: ________________________________________ DOB/Age:

________________________________________
________________________________________ Referring M.D.:

Phone: Date:

almost almost
always usually sometimes seldom never

5 4 3 2 1
I recall things I was told or did yesterday.
I remember where things are kept.
I remember to take belongings with me and not
leave them behind.
I remember to do what I said I would do.
I remember details of my daily routine.
I rarely retell a story or joke to the same person.
I recall what I am supposed to do in the future (I keep
my appointments).
I recall stories I hear on the news.
I recall stories I read in the paper.
I can concentrate for long periods of time.
I can ignore distractions.
I can do two things at once.
I have no difficulty coming back to something after
an interruption.
I rarely catch myself daydreaming.
I rarely get so deeply involved in a task that I forget
other obligations.
I rarely get lost.
I have no difficulty learning a new skill.
I rarely feel confused.
I find it easy to make decisions.
I find it easy to pick up new skills.

The Source for Executive Function Disorders 32 Copyright © 2003 LinguiSystems, Inc.
 Assessment

Patient-Initiated Continuum (PIC)

I n 1989, Lomas1, et al., published a measure of functional com-
munication for adult aphasics, The Communicative Effect-
iveness Index (CETI). The CETI is a 16-item rating of communication
situations allowing the individual with aphasia, a significant other,
and the clinician an opportunity to judge the aphasic’s functional com-
munication1.

The premise of the CETI can be modified to provide a patient-driven

assessment and treatment tool via the Patient-Initiated Continuum,
or PIC. PIC is a tool targeted to high-level cognitive and/or language
impaired patients, as these patients have the greatest ability to under-
stand their deficits and the impact these deficits have on daily func-
tioning. (Three examples of completed PICs are on pages 35-36.)

Methods
1. The patient is asked to identify 5-10 specific skills he or she feels are
impaired and adversely affect daily performance at home and/or
work. Frequently, patients require cues to generate highly specific
items. For example, “I can’t remember anything” would spur queries
to determine if the patient was describing reductions in memory for
material heard vs. read, immediate recall vs. delayed, familiar vs.
novel, etc. With guidance from the therapist, the patient generates
characteristics of his or her deficit and the functional impact.

2. These characteristics are next transcribed on paper in a landscape

fashion with a 10-inch line drawn above each item. The far left-
hand margin is labeled “Fully Unacceptable” and “Fully Acceptable”
is written on the far right-hand margin.
1
Lomas J., Pickard L., Bester S., Elbard H., Finlayson A., Zoghaib C. (1989). The commu-
nicative effectiveness index: development and psychometric evaluation of a functional
measure for adult aphasia. Journal of Speech and Hearing Disorders, 54:113-124.

The Source for Executive Function Disorders 33 Copyright © 2003 LinguiSystems, Inc.
 Patient-Initiated Continuum

3. The patient is then asked to mark where on the continuum the patient feels his or her
skills currently fall. Using a 10-inch line, the therapist can extrapolate these marks
to percentages. For example, a mark at the 5½ inch point indicates that the patient
perceives his or her performance to be 55% of personal expectation. (Note: the exam-
ples presented on pages 35-36 are shown at 50% of actual size.)

4. The patient will again rate his or her level on the continuum during and at the end of
treatment, providing a visual and numerical comparison of progress.

Parameters of treatment can be fashioned from the deficits stated by the patient. The
fact that the patient volunteered specific areas predisposes his or her interest in that
area.

Summary
The PIC, used as an adjunct to formal assessment tools, provides several advantages:
➤ It actively involves the patient in understanding his or her impairment. It requires
patients to put into daily terms what they find difficult, regardless of clinical test
scores. The patient’s ability or inability to verbalize specific areas of difficulty indi-
cates the level of explanation and counsel needed to accompany treatment. For
example, a patient who independently identified that material read is easier to
recall than lectures does not require the same introduction and explanations as one
who could not identify this difference.
➤ The PIC actively involves the patient in goal-setting. By participating in the PIC,
the patient has shown what problems he or she notes and values as important to
remedy. By comparing the PIC to formal test results, the therapist can prioritize
which areas are impaired and which ones the patient wishes to address. Perhaps
the patient scored poorly on an assessment of math yet never mentioned any math
focus on the PIC. This is clearly not an area of priority to the patient.
➤ The PIC provides a comparison between perception and reality. Deviations between
performance on formal test measures and the PIC can demonstrate how accurately
the patient is able to judge his or her own performance. The PIC can also highlight
the advantages or disadvantages a clinical testing situation provides.
➤ The PIC provides a method of quantifying patient performance and improvement.
A percentage or number score can be assigned to each mark on the continuum.
Patients serve as their own control; therefore, a therapist can report that the patient
improved from an initial assessment to discharge assessment on a particular goal
by a quantified amount.

The Source for Executive Function Disorders 34 Copyright © 2003 LinguiSystems, Inc.
 Patient-Initiated Continuum

PIC Example 1
Fully Fully
Unacceptable Acceptable
X
Remembering work schedule in my head
X
Remembering family/social schedule in my head
X
Budgeting my time well at work
X
Staying on track with the priorities I do set — maintaining focus
X
Bluntness in communication
X
Indecisiveness in social decisions

PIC Example 2
Fully Fully
Unacceptable Acceptable
X
Ability to use vocabulary desired
X
Ability to know/recall/keep appointments
X
Ability to reschedule from memory
X
Ability to organize self better in the mornings to get out of house (not sidetracked)
X
Ability to finish one task before beginning another
X
Ability to SEE what is in front of me when I look

The Source for Executive Function Disorders 35 Copyright © 2003 LinguiSystems, Inc.
 Patient-Initiated Continuum

PIC Example 3
Fully Fully
Unacceptable Acceptable
X
Thinking at a reasonable speed
X
Focusing attention for reading
X
Being on time for appointments
X
Telling a story concisely and purposefully
X
Remembering details from meetings
X
Focusing attention for the entire meeting

The Source for Executive Function Disorders 36 Copyright © 2003 LinguiSystems, Inc.
 Assessment

Reports and Documentation

T he use of standardized and informal assessment tools is the

determinant of the presence or absence of executive function
disorders.
➤ Are the patient’s complaints consistent with executive
function disorders?
➤ Are these complaints demonstrated via normative data?
➤ Are these complaints demonstrated via quantified infor-
mal assessment?
➤ Can these deficits be attributed to any other physical
and/or psychological cause?
Documenting findings and developing appropriate long- and short-
term goals are key, not only to successful treatment, but also for reim-
bursement and developing a referral base. Each facility will have its
own method for documentation; however, several sections should be
included.

History
This section includes a summary of the information gained during the
interview with the patient and any accompanying medical reports. It
includes the nature and severity of the injury, medical conditions, and
medical treatment. It also will include the patient’s educational and
occupational situation and his or her complaint. The history section of
the report establishes the medical indications for the referral.

This 37-year-old male was involved in a motor vehicle accident

on 4/1/03. He does not report any loss of consciousness. He
was treated in the emergency department of his local hospital.
CT and MRI scans were negative. Since returning to work he

The Source for Executive Function Disorders 37 Copyright © 2003 LinguiSystems, Inc.
 Reports and Documentation

reports difficulty in concentrating. He finds himself easily distracted. He reports

missing appointments and forgetting engagements. He has been examined by a
neurologist. A repeat CT demonstrated mild frontal lobe involvement bilaterally.
Mr. B is a high school graduate who has been employed for 10 years as a supervi-
sor of over 20 people. He does not take any medications on a regular basis and
denies any alcohol or drug abuse.

Ms. S, a 60-year-old female, was diagnosed with a left frontal meningioma 3

months ago after suffering a seizure. She underwent a craniotomy and resection.
No radiation or chemotherapy was recommended. All follow-up exams have been
unremarkable. Ms. S complains that since the surgery she “does not feel like doing
anything.” She has not returned to her leisure activities and reports frequently
failing to grocery shop and pay bills. Ms. S is a widowed homemaker with 2
grown children and 4 grandchildren who live nearby. She is currently taking
Dilantin and denies alcohol or drug use.

Subjective
This section allows the therapist to offer subjective, yet clinical, observations regarding
the patient and his or her response to the testing environment. For example:
➤ Did the patient arrive on time to the appointment?
➤ Was the patient’s appearance consistent with expectations?
➤ Was the patient able to attend to the questions?
➤ Did the patient answer questions in a concise or haphazard manner?
➤ Did the patient have a good understanding of his or her deficits?
➤ Could the patient attend to the assessment?
➤ Were breaks required?
➤ Did the patient require frequent redirection?
➤ How did the patient respond to difficult tasks?

Subjectively, the patient appeared anxious about the testing situation. He ver-
bally stated that he was nervous and displayed nervousness throughout the ses-
sion. He was slow to respond throughout the session. He appeared to take a great
deal of time to think through each response, even those that should be fairly auto-
matic. Mr. B requested several breaks within the 1-hour session. He was, how-
ever, able to understand and carry out instructions without repetitions.

Ms. S arrived 15 minutes late for her scheduled appointment. She reported get-
ting lost even though she is familiar with this building. Ms. S appeared
disheveled in her appearance. She did not accept any suggested breaks during the
assessment session even when she had obviously lost her attention to the task. It

The Source for Executive Function Disorders 38 Copyright © 2003 LinguiSystems, Inc.
 Reports and Documentation

was difficult for her to maintain attention to a task or conversation for more
than 5 minutes. When finished, Ms. S had difficulty locating her schedule
book and requested to call later to schedule the next session. After 3 days she
had not called and was therefore recontacted. At that time, she expressed her
frustration at forgetfulness and scheduled the next appointment.

Test Score Reporting Results

Name: Medical Record Number:
This part of the report contains specific test scores.
Address: ________________________________________ DOB/Age:
These are easy to report in a table/grid format, such
________________________________________
________________________________________ Referring M.D.: as the one provided on page 43 and pictured here.
Phone: Date:

Non-standardized scores are more difficult to report

in a table format and frequently require more
Test Name Number Correct Percentile for Age

QRST 15/30 = 50% 43rd description. For example,

1234 12/20 = 60% 38th
XYZ 4/10 = 40% 30thThe patient was able to read a complete news-
paper article (8 paragraphs) and answer ques-
tions regarding its content; however, this took
over 15 minutes. When the patient was
required to read the entire article in 5 minutes, performance dropped such
that only 3 paragraphs were complete and accuracy of information for those
3 paragraphs was 55%.

When asked to check his own work, Mr. B was unable to identify any errors.
When errors were pointed out to him, he was successful in making correc-
tions.

When the most difficult portions of the test were administered first, the
patient performed well on these. Her performance declined over time
despite the declining level of difficulty.

The Results section will also include functional statements regarding the patient’s
performance in daily tasks. For example,

Functionally, he comprehended and participated in adult conversation in

the therapy room without difficulty. He recalled specifics and details of a
general conversation without difficulty. When conversation was moved to a
noisy environment, he had difficulty recalling even the main point of the
conversation several minutes later. He expressed himself in complete, adult-
level sentences with only occasional instances of word retrieval difficulties.
His reading and writing were also at adult levels when conducted in a quiet
environment. He had difficulty recalling the main point of a newspaper he
scanned in the waiting room. In all conversation he appeared deliberate, as
if it was difficult for him to maintain this level of performance. He showed

The Source for Executive Function Disorders 39 Copyright © 2003 LinguiSystems, Inc.
 Reports and Documentation

decline in all aspects of attention, both in the testing situation and in con-
versation. He was fairly accurate in identifying instances of reduced atten-
tion in this setting, frequently stating, “I’m not getting it.” He often lost his
train of thought. His awareness of this was fairly good, but his ability to
self-correct was limited.

Functionally, Ms. S showed adequate focused and sustained attention for

general conversation and for specific testing items. Despite this, she fre-
quently complained that her “mind wants to be somewhere else.” She did
show reductions in divided and alternating attention both during struc-
tured testing and informal observation. She had a great deal of difficulty
with tasks that required her to perform 2 functions simultaneously or alter-
nate between 2 tasks. This was also noted in non-testing situations. Her
ability to focus her attention in a distracting environment showed a signif-
icant reduction relative to her skill in a non-distracting environment.

Interpretation
Assigning a severity level to the executive function disorder, based on functional
skills, is helpful in gradating the problem and judging improvement.
Severe Profound difficulties resulting in an inability to per-
form daily functions for home and/or work tasks.
Inability to successfully use compensatory strategies.
Moderately Severe Inconsistent ability to generate and select appropri-
ate goals, sequence the steps involved, and evaluate
performance. Emerging ability to utilize compensa-
tory strategies. Performance at home and work con-
tinue to be inconsistent.
Moderate Consistent ability to generate and select goals and
sequence the steps involved for 1-2 tasks.
Difficulties in time management, speed of response,
and evaluation of performance are present. Skills
dramatically decline with increasing numbers of
tasks. The use of compensatory strategies is consis-
tent, but it is not comprehensive.
Mild-Moderate Consistent ability to generate and select goals and
sequence the steps involved and develop appropriate
time references for multiple tasks. Speed of response
and self-evaluation continue to show deficits. Use of
compensatory strategies is consistent.
Mild Ability to operate at home and work using compensa-
tory strategies. Difficulties in multiple task organi-
zation, high-level organization, speed of response and
behavioral self-management continue to be evident.

The Source for Executive Function Disorders 40 Copyright © 2003 LinguiSystems, Inc.
 Reports and Documentation

Minimal Ability to perform most all tasks necessary for home

and work via compensatory techniques.

Goals
Goals of treatment must be:
➤ quantifiable
➤ measurable
➤ functional
➤ attainable

Each patient will have an entirely different set of long- and short-term goals specific
to his or her particular needs. Identify areas of deficit based upon the results of both
formal and informal testing. Determine what clinical parameters are involved in the
patient’s PIC responses. For instance, Example 1 on page 35 stated “Remembering
family/social schedule in my head” as the patient’s least acceptable item. Does the
patient even know his or her schedule? Is it a realistic schedule? Is the schedule
written down? Have any attempts at memorization been made, or is it expected to
be automatic? Example 2 on page 35 stated “Ability to organize self better in the
mornings to get out of the house (not sidetracked)” as most problematic. Goals for
this patient would include establishing realistic schedules and routines and improv-
ing selective attention. Example 3 on page 36 listed “Focusing attention for the
entire meeting” as the patient’s biggest difficulty. Focus on sustained attention
would be an important goal for the patient to meet.

The therapist and the patient must mutually agree upon goals, and this agreement
must be documented in the report.

➤ Long-term goals are those to be accomplished over the course of treatment. They
are functional and are the “end-product” of treatment. Here are some examples:
• Consistent ability to identify necessary tasks for the day
• Consistent ability to sequence tasks and components of tasks
• Consistent ability to prioritize activities of the day
• Consistent ability to anticipate time constraints and requirements
• Consistent ability to modify plans based upon new information
• Attention skills adequate to participate in 30 minutes of adult conversa-
tion in a noisy environment
• Attention skills adequate to read for 30-40 minutes with adequate com-
prehension and retention
• Reading of an adult-level newspaper article, 8-10 paragraphs, in 5 min-
utes with adequate comprehension and retention
• Written production of 1-2 pages of adult level information with appro-
priate vocabulary and syntax, produced within 15 minutes

The Source for Executive Function Disorders 41 Copyright © 2003 LinguiSystems, Inc.
 Reports and Documentation

Patients with executive function disorders must employ a great many compen-
satory strategies during their treatment, and often throughout life. They must
be cognizant of these strategies and their uses. The therapist will develop and
instruct in the use of compensations but the patient must know and use them.
Therefore, long-term goals will be reflective of this. Here are some examples:
• Consistent knowledge and use of compensatory strategies to improve
attention
• Consistent knowledge and use of compensatory strategies to improve
memory
• Knowledge of and independent use of an organizational system to man-
age time

➤ Short-term goals are more clinical. They are specific tasks utilized in order to
meet long-term goals. Their relationship to the long-term goals must be evident.
Do not assume that the referring physician or the payer understands the corre-
lation between visual scanning tasks and attention. Short-term goals are typi-
cally established for a 3-4 week duration. Specific performance criteria should
be stated along with the cues, if any, needed to achieve this level. Here are some
examples of short-term goals:
• Ability to define 5 techniques to improve memory and the ability to use
these techniques in treatment tasks when provided with an initial cue to
do so
• Ability to state 2 strategies to maximize selective attention and the
ability to use them consistently in clinical situations
• 90% accuracy in paper and pencil tasks requiring alternating and divided
attention
• 90% accurate ability to complete simple pen and paper tasks with com-
peting auditory stimuli
• Ability to sustain attention to reading of 3-4 paragraphs of adult level
material interesting to the patient with 85% accuracy answering ques-
tions about the passage 15 minutes later
• Ability to accurately proofread 1 page of written material and make
corrections
• Consistent ability to record time and date of therapy appointments in the
patient’s organizational system
• Accurate time estimations, within 10 minutes, for 10 activities within the
patient’s day

The Source for Executive Function Disorders 42 Copyright © 2003 LinguiSystems, Inc.
 Test Score Reporting

Name: Medical Record Number:

Address: ________________________________________ DOB/Age:

________________________________________
________________________________________ Referring M.D.:

Phone: Date:

Test Name Number Correct Percentile for Age

Comments _______________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________

The Source for Executive Function Disorders 43 Copyright © 2003 LinguiSystems, Inc.
 Treatment

General Treatment Guidelines

C ollecting the patient history and description of the complaint

provided the blueprint for conducting the evaluation.
Thorough evaluation via formal and informal measures confirmed and
quantified the executive function disorders. The evaluation results
provided a template to develop mutually determined goals for treat-
ment. Working through systematic activities to achieve these goals is
the next step.

Here are some general guidelines for planning treatment:

➤ Appreciate how the impairment aimed at remediation
affects a patient’s ability to understand, integrate, and
retain information.
➤ Simplify the information provided. Try to use the patient’s
wording.
➤ Provide multiple trials, a slowed rate of presentation,
well-organized written summaries and assignments, and
session summaries.
➤ Be an active listener. Hear what the patient is saying and
plan/modify the treatment based upon this active listen-
ing. Don’t be so intent on completing your plan that you
miss a perfect opportunity to address another goal in a
meaningful way.

Metacognitive Processes
In the course of treatment, patients will be instructed to think about
how they think. The patient will need to gain knowledge about cogni-
tive processes, and through treatment, the patient will be assisted in
developing or rediscovering strategies.

The Source for Executive Function Disorders 45 Copyright © 2003 LinguiSystems, Inc.
 General Treatment Guidelines

What exactly is a strategy? It is a tool, plan, or method used for accomplishing a task.
As patients develop strategies they will:
➤ learn that there is more than one right way to accomplish a task.
➤ be able to identify their mistakes and try to rectify them.
➤ evaluate their end results.

In order to successfully instruct the patient in the use of strategies, the therapist
should follow these steps:
1. Describe the strategy. Allow the patient to obtain an understanding
of the strategy and its purpose: why it is important, when it can be used,
and how to use it.
2. Model the strategy’s use. Utilize the strategy during treatment ses-
sions, providing direct models of the strategy, and explaining to the
patient how to use the strategy in the particular situation.
3. Provide practice tasks. Provide the patient with opportunities to
practice using the strategy in both functional and clinical tasks. Provide
cues and feedback on the appropriate and accurate use of the strategy.
4. Promote self-monitoring and evaluation. Patients will use the
strategy if they see how it assists them in meeting their goals.

The challenge in all therapy is for the patient to transfer and utilize the skills mas-
tered during treatment sessions and structured activities in his or her everyday life.
Carryover is a topic traditionally reserved for the end of treatment; however, the end
product of therapy must be considered from the first day of involvement with the
patient. Transfer is not automatic and must be addressed from the onset. Factors
that influence generalization include the following:
➤ the degree to which the patient has attained automatic mastery of
the skill
➤ an understanding of when the skill may be useful
➤ knowing how to modify the skill to fit different situations
➤ confidence and knowledge that the skill will be useful and successful in
different situations.

Achieving carryover is most easily achieved by utilizing everyday situations through-

out therapy. Occasionally, highly clinical, contrived tasks are necessary to train a
skill, but the functional, daily application of that skill and task must be clear to the
patient.

The Source for Executive Function Disorders 46 Copyright © 2003 LinguiSystems, Inc.
 General Treatment Guidelines

Self-Assessment
The ability to anticipate performance, accurately judge correct performance, and
make modifications for future performance addresses the executive function disorder
characteristics of self-regulation and use of feedback. Prior to completing tasks dur-
ing treatment sessions and as homework, provide the patient with a copy of the
Performance Checklist on page 48. Ask the patient to complete the first shaded
column of the checklist (Predicted Performance Rating) using the following scale:

7 = I can complete this activity accurately and independently.

6 = I can complete this activity accurately with minimal cues.
5 = I can complete over half of this activity accurately and independently.
4 = I can complete over half of this activity accurately, given cues.
3 = I can complete less than half of this activity accurately and independently.
2 = I can complete less than half of this activity, given cues.
1 = I cannot complete this activity accurately, even with cues.

At the completion of the task, have the patient complete the second shaded column
and the far right-hand column of the Performance Checklist to judge actual per-
formance on the task(s). The ability to develop an accurate self-perception is an
important element of executive functions.

The Source for Executive Function Disorders 47 Copyright © 2003 LinguiSystems, Inc.
 Performance Checklist

Name: Medical Record Number:

Address: ________________________________________ DOB/Age:

________________________________________
________________________________________ Referring M.D.:

Phone: Date:

Directions for Completing the Checklist Rating Scale

1. Describe the task in the first column. 7 I can complete this activity accurately and
independently.
2. Use the Rating Scale to the right to predict 6 I can complete this activity accurately with
how well you will perform on the task. minimal cues.
3. Do the task. 5 I can complete over half of this activity accurately
and independently.
4. Use the Rating Scale to the right to record 4 I can complete over half of this activity accurately,
your actual performance on the task. given cues.
5. Note the variance between your prediction 3 I can complete less than half of this activity
accurately and independently.
and your actual performance, and provide
2 I can complete less than half of this activity,
any reasons for the variance. given cues.
1 I cannot complete this activity accurately, even
with cues.

Predicted Actual
Task Performance Performance Variance/Reason
Rating Rating

The Source for Executive Function Disorders 48 Copyright © 2003 LinguiSystems, Inc.
 Treatment

Time Management

O ne of the skill deficits of executive function disorders is the

inability to properly manage time. Time management includes
the ability to understand, be aware of, and regulate activity according
to time constraints.

There are four divisions of time management:

➤ Time estimation: the ability to judge the passage of time
in general, and the ability to judge how long completion of
a task will take
➤ Time schedules: the capability to generate an accurate
and realistic time schedule
➤ Completion of scheduled activities: the ability to exe-
cute tasks in accordance with time schedules
➤ Alterations: the capacity to modify the schedule when
new information is presented or when the original plan
goes awry

Helpful Hint: Knowledge about time management Everyone has variable time manage-
can be found in many forms. The ment abilities. Many people, including
those without any documented injury,
information provided in business pub-
have difficulty arriving on time to
lications is often more appropriate events, planning an appropriate num-
than that typically found in therapy ber of activities in a day, and/or alter-
publications. Make it a habit to walk ing their plans. While not expecting all
through the business section in the patients to become scheduling wizards,
library and read magazines pertaining imposing some form of structure on
to work habits and time management. these divisions of time is key.

The Source for Executive Function Disorders 49 Copyright © 2003 LinguiSystems, Inc.
 Time Management

External System
Using an external time management system
is an excellent starting point for the patient Helpful Hint: If the patient is not accustomed to
with executive function disorders. There are external organization and time man-
many commercially-available time manage- agement tools, you will need to
ment systems. Traditional black three-ring expose him or her to the options.
binder “memory books” are not typically Maintain examples and/or catalogs
appropriate with this population. If the for various time management sys-
patient already uses a particular system, tems, such as DayPlanner, Filofax,
allow the patient to continue with this sys- Franklin Planners, and Palm Pilots.
tem, making necessary modifications. Learn the pros and cons of each.
The system must be large enough to hold the
required information but small enough to be carried at all times. It should be used
for both home and work activities. These elements must be included:
➤ full month calendar
➤ daily pages with time slots
➤ “to do” section
➤ daily log or diary section
➤ blank pages

The only system that will work is one that the patient will actually use. It is impor-
tant that the patient be responsible for selecting a tool that fits his or her style. Once
the patient has selected a system, begin by introducing and structuring the use of the
system in measurable steps. The patient will need to bring his or her calendar sys-
tem to every session, and ultimately, throughout all daily encounters. Treatment
tasks and homework will focus on working through the steps needed to master the
system, and thus, provide retraining and compensation for deficits in the four divi-
sions of time management. Each patient will work through these treatment phases
at a different pace. Some phases can easily be completed during therapy
sessions, and some are more appropriately given for homework. They are cumula-
tive. Once the patient has completed a phase during a session and/or for homework,
you should continually check and evaluate this phase to establish a habitual nature.

Phase 1: Engraved in Stone

During the initial sessions of treatment Helpful Hint: If national and religious holidays are
and for homework, use the full month and not pre-established in the calendar
daily calendars to have the patient enter all system, cue the patient to fill these
birthdays, anniversaries, and holidays (any in also.
events that will not change).

The Source for Executive Function Disorders 50 Copyright © 2003 LinguiSystems, Inc.
 Time Management

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

1 2 3 4 5 6 7
Do Wash 9:00 Meet Get Gasoline Lauren Clothes to
with Bob. Birthday Cleaners
12:00 Lunch Grocery
6:00 Meeting Shop
8 9 10 11 12 13 14
Do Wash Pick up 10:00 DDS Grocery James
Clothes Shop Birthday

15 16 17 18 19 20 21
Do Wash 12:00 Jan Mom & Dad Get Gasoline Grocery Clothes to
Lunch Anniversary Shop Cleaners

22 23 24 25 26 27 28
Do Wash Pick Up Grocery Pay Day 8:00 Party
Clothes Shop

29 30 31
Do Wash Holiday
2:30 Picnic

OCTOBER 5 Lauren Birthday

8:00
9:00
10:00
11:00
12:00
1:00
2:00
3:00
4:00
5:00
6:00
7:00
8:00

The Source for Executive Function Disorders 51 Copyright © 2003 LinguiSystems, Inc.
 Time Management

Documentation:
➤ What percentage of recurring items were entered into the calendar?
➤ What percentage were on both the monthly calendar and the daily calendar?
➤ How many and what type of cues were required to achieve this level of accuracy?
➤ What type of errors were produced?
Helpful Hint: For some schedules, entering all
information in the monthly calendar
Phase 2: Scheduled Events section may be too crowded. Work to
Once the “engraved in stone” items have determine which appointments
been successfully accounted for, have the should be listed on both the monthly
patient enter all scheduled appointments and the daily schedule.
and events in the appropriate time slot on
the appropriate day. Anything that must be done at a particular time should be
included:
➤ Begin with already scheduled doctor and dentist appointments.
➤ Enter all regularly occurring meetings.
➤ Enter all regularly occurring activities.

Example (New items are in boldface in all examples.):

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

1 2 3 4 5 6 7
Do Wash 9:00 Meet Get Gasoline Lauren Clothes to
with Bob Birthday Cleaners
12:00 Lunch Grocery
6:00 Meeting Shop
8 9 10 11 12 13 14
Do Wash Pick up 10:00 DDS Grocery James
Clothes Shop Birthday

15 16 17 18 19 20 21
Do Wash 12:00 Jan Mom & Dad Get Gasoline Grocery Clothes to
Lunch Anniversary Shop Cleaners

22 23 24 25 26 27 28
Do Wash Pick Up Grocery Pay Day 8:00 Party
Clothes Shop

29 30 31
Do Wash Holiday
2:30 Picnic

The Source for Executive Function Disorders 52 Copyright © 2003 LinguiSystems, Inc.
 Time Management

OCTOBER 3
8:00
8:30 Meet with Bob
9:00
10:00
11:00
12:00 Lunch at Main Street
1:00
2:00
3:00
4:00
5:00
6:00 Meeting at Club
7:00 Dinner

Helpful Hint: Many patients are hesitant to relinquish

Once events that have already been sched-
appointment cards or “sticky notes” in
uled are entered on the calendar, begin to
favor of writing all information into the
train the patient to consistently enter all new
calendar. Consider incorporating an
appointments and obligations directly into
envelope into the organizational book to
the calendar.
keep these cards.

At each session, review the calendar:

➤ Ask patients whether they carry the calendar with them everywhere.
➤ Have any appointments, obligations, parties, meetings, etc., been
scheduled since the last treatment session?
➤ Have these new events been documented in the calendar system?
➤ Are the events documented in the appropriate location?

Documentation:
➤ What percentage of appointments/events were written down?
➤ How many were not written down correctly?
➤ What kept the patient from entering the correct information consistently?
➤ Was there a pattern to the errors?
➤ What type of cues assisted the patient in improving his or her accuracy?

Now that those appointments and obligations determined by others have been
accounted for, it’s time to fill in the remainder of the tasks needed for each day.

The Source for Executive Function Disorders 53 Copyright © 2003 LinguiSystems, Inc.
 Time Management

Phase 3: Time Estimation

Estimating the time necessary to complete tasks is imperative and typically an
area where patients develop an impasse. The patient may grossly over or under-
estimate the length of time a task requires. Making this mistake throughout the
day can result in being hours off in scheduling. Over time, these hours translate
into being days and weeks off schedule.

Prior to successfully slotting activities into appropriate time frames, provide the
patient with practice judging the amount of time particular activities take to com-
plete. For homework, provide the patient with a copy of the Time Estimation
Worksheet on page 72 and have him or her follow these directions:
➤ Complete a simple table comparing the length of time the patient esti-
mated a task would take to the actual time it took to complete.
➤ Carry out this exercise for a large variety of tasks (getting dressed,
making phone calls, driving to appointments, shopping, etc.).
➤ Carry out this exercise for a number of days.

Analyze the table with the patient during a Helpful Hint: Complete the Time Estimation
session. Consider the number of tasks Worksheet yourself and ask your
where needed time was over or underesti- friends to do so. Everyone is off in
mated. Does the patient have an explana- their estimations a bit. Develop a
tion for any discrepancies? Is there a pat- sense of what is a normal fluctuation
tern to the patient’s errors, such as morn- as opposed to impaired ability.
ing vs. afternoon tasks, physical vs. mental
tasks, etc.

The patient should continue with this exercise until his or her ability to accurately
estimate the durations of tasks has been achieved. A completed example of a por-
tion of the Time Estimation Worksheet is shown below. Tasks and activities
that are appropriate for this activity include the following:
➤ showering or getting ready in the morning
➤ driving to work, school, or regular locations
➤ grocery shopping
Task Estimate Actual
➤ reading the newspaper
➤ making a meal Shower 5 min. 10 min.

➤ changing sheets on a bed Drive to Store 10 min. 10 min.

➤ washing the dishes Make Dinner 20 min. 35 min.
➤ cleaning a room Do Dishes/Clean Up 10 min. 15 min.
➤ mowing the grass Talk with Mom 10 min. 5 min.
➤ writing a letter or report

Include additional activities specific to the patient’s needs and daily routines.

The Source for Executive Function Disorders 54 Copyright © 2003 LinguiSystems, Inc.
 Time Management

Documentation:
➤ How many minutes or hours were over/underestimated?
➤ Was there a pattern to the errors?
➤ Were physical tasks more consistently miscalculated compared to mental?
➤ What percentage of activities were correctly estimated?
Once the patient has a good feel for how long tasks take, begin to calculate how
many hours of the day are consumed by daily routines, work, chores, and other
activities.

Phase 4: How Many Hours in a Day?

There are only so many hours in a day. Patients with executive function disorders
have difficulty planning realistic schedules. They need to understand that every
slot on the time grid cannot be filled with activity. Patients need help planning for
both the incidentals and necessities in the day.

Walk the patient through the exercise of recognizing available time in the day.
Have the patient complete a Time Available Equation on page 73. This math-
ematical exercise will visually demonstrate both the number of hours in a day that
are consumed by already established activities and the “free,” available time
remaining.

Begin with 24 hours, and consider the following:

➤ How many hours does the patient sleep? Is the patient cheating his or her
sleep to make more time in the day?
➤ Has the patient allotted time to eat? Again, patients often view this as a nego-
tiable activity to steal more time. At the minimum, 3 meals will take 30 min-
utes of the day.
➤ Is the patient responsible for making these meals? How long does that take?
What about the cleanup?
➤ Within the calculation, consider that it is typical to spend another half hour
of each day, minimum, on miscellaneous activities such as getting a drink,
using the bathroom, wasting a minute or two here or there, etc.
➤ How long does the patient’s morning routine take? Evening/bedtime routine?

Next consider activities specific to the patient beyond sleeping, eating, and
hygiene. This list will be particular to the patient. Patients often have difficulty
coming up with such tasks on their own. Anticipate what obligations the patient
may have and query the patient to determine what is included in the Time
Available Equation. Here are some questions you might ask the patient:
➤ Do you commute?
➤ Are there standing commitments/obligations that take time?
➤ Do you drive others/children to school or various activities?

The Source for Executive Function Disorders 55 Copyright © 2003 LinguiSystems, Inc.
 Time Management

➤ Are you responsible for household Time Available

duties such as washing, shopping, Write daily tasks on the lines below and the amount of time (in hours) tasks take in the shaded
cooking, and cleaning? boxes. Continue subtracting from the subtotals to calculate the time available every day outside
of normal tasks and routines.

Have the patient generate a list of time

commitments, estimate the length of time 24 hours in a (circle one) day work week
needed to to accomplish each, and begin to sleeping
— 8 ____________________________________________________________________
subtract those periods from the 24-hour
baseline. The top example on this page is 16 subtotal

based on a 24-hour day and the bottom — 8 at work

____________________________________________________________________
example is a work setting equation that
8
reflects a typical 40-hour work week. subtotal

— 1.5 eating
____________________________________________________________________

The person who completed these equations 6.5 subtotal

found that he had just 5 available hours at morning/evening routine

1
home every day and 7.5 “free” hours at — _____________________________________________________________________

work each week. Typically, what is discov- 5.5 subtotal

ered by this exercise is the patient’s unre- — .5 miscellaneous (getting a drink, using bathroom, etc.)
_____________________________________________________________________
alistic expectation of how many hours are
available in any given day to complete indi- 5 Total Hours Available

vidual obligations. This Time Available

Equation should be thought of as an ongo-
ing process that the patient evaluates fre-
quently.

During this activity, the concept of plan- Time Available

ning should be introduced. Emphasize to Write daily tasks on the lines below and the amount of time (in hours) tasks take in the shaded
boxes. Continue subtracting from the subtotals to calculate the time available every day outside
patients that a half hour of planning will of normal tasks and routines.

save one hour of wasted time.

40 hours in a (circle one) day work week
Often, the pressure of having too much to scheduled meetings
— 5 ____________________________________________________________________
do results in diving into the day without
proper organization. It is essential that 35 subtotal

patients with executive function disorders — 10 writing

____________________________________________________________________
come to understand and believe that this
25
half hour planning time is necessary for
subtotal

on the phone
success. This 30 minutes of planning — 10 ____________________________________________________________________

should be reflected in the time available 15 subtotal

calculations, reducing the available time in unscheduled meetings, questions, etc.

— 5 _____________________________________________________________________
the home example above to 4.5 available
hours in a day and to 5 hours a week in the 10 subtotal

work example (30 minutes every day for 5 — 2.5 miscellaneous (getting a drink, using bathroom, etc.)
_____________________________________________________________________
work days).
7.5 Total Hours Available

The Source for Executive Function Disorders 56 Copyright © 2003 LinguiSystems, Inc.
 Time Management

OCTOBER 3
6:00 Wake and Shower
7:00 Eat Breakfast
8:00 Planning
8:30 Meet with Bob
9:00
10:00
11:00
12:00 Lunch at Main Street
1:00
2:00
3:00
4:00
5:00 Organize for Tomorrow
6:00 Meeting at Club
7:00 Dinner

What about the time requirements before and after each activity? Does the patient
allow for travel time or preparation time? This lack of planning contributes to tar-
diness and the constant feeling of being “behind” that patients with executive func-
tion disorders express. Help the patient to adequately schedule time for travel and
preparation.

OCTOBER 3
6:00 Wake and Shower
7:00 Eat Breakfast
7:30 Leave for Work
8:00 Planning
8:30 Meet with Bob
9:00
10:00
11:00
11:30 Drive to Lunch
12:00 Lunch at Main Street
1:00 Drive Back from Lunch
2:00
3:00
4:00
5:00 Organize for Tomorrow
5:30 Drive to Meeting
6:00 Meeting at Club
7:00 Drive Home
7:30 Dinner

The Source for Executive Function Disorders 57 Copyright © 2003 LinguiSystems, Inc.
 Time Management

Documentation:
➤ What percentage of total time-consuming activities was the patient able to
identify independently?
➤ What types of cues were required to reach an adequate level of performance?
➤ How many hours does the patient have available in a day? In a week?
Throughout the month?
➤ Did the patient complete a Time Available Equation on a regular basis?
What types of cues were required for this performance?

Phase 5: Routines
Establishing routines can be an important aspect of time management. Many rou-
tine, daily tasks are difficult for patients with executive function deficits because
they over- or under-attend to them. Patients frequently neglect daily tasks
because they can’t fit them into the day, or conversely, they spend too much time
and attention on routine tasks for fear of forgetting them. Establishing a routine
time for each task can insure its completion.

Discuss with the patient which aspects of daily life can be fairly routine and sched-
uled as such. If a patient describes never having time to leave and pick up clothes
from the dry cleaner, consider whether this can be scheduled every Friday at 5:30.

Refer to the Time Estimation Worksheet

Helpful Hints: Just because the phone is ringing does
and Time Available Equation to help the
patient determine what activities occur reg- not mean it must be answered. View
ularly. Here are some typical routines: the phone as a tool to assist, not con-
trol. If the patient reports getting off
➤ waking up task at work or home because he or
➤ performing morning routine she becomes distracted by the phone,
➤ performing evening routine schedule a time to take and receive
➤ grocery shopping calls and rely on voice mail for the
others. Establish a schedule for check-
➤ doing laundry
ing voice mail messages and returning
➤ taking clothes to dry cleaners calls every day at routine times.
➤ doing errands
➤ housecleaning Some patients describe becoming dis-
➤ maintaining car tracted by the E-mail alarm when
working online. Have the patient
learn how to disengage the visual and
Work with the patient to assign these tasks to auditory alarm feature during work
specific, routine times, taking appropriate periods. Schedule a routine time to
consideration to the time needed for each. check and answer E-mail.
Have the patient enter these routines into his
or her monthly and daily calendar. Touch mail only once and act on it
immediately: file it, refer it to some-
one else, or throw it out.

The Source for Executive Function Disorders 58 Copyright © 2003 LinguiSystems, Inc.
 Time Management

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

1 2 3 4 5 6 7
Do Wash 9:00 Meet Get Lauren Clothes to
with Bob Gasoline Birthday Cleaners
12:00 Lunch Grocery
6:00 Meeting Shop
8 9 10 11 12 13 14
Do Wash Pick up 10:00 DDS Grocery James
Clothes Shop Birthday

15 16 17 18 19 20 21
Do Wash 12:00 Jan Mom & Dad Get Grocery Clothes to
Lunch Anniversary Gasoline Shop Cleaners

22 23 24 25 26 27 28
Do Wash Pick up Grocery Pay Day 8:00 Party
Clothes Shop

29 30 31
Do Wash Holiday
2:30 Picnic

OCTOBER 3
6:00 Wake and Shower
7:00 Eat Breakfast
7:30 Leave for Work
8:00 Planning
Check Voice Mail
Check E-mail
8:30 Meet with Bob
9:00 Morning Phone Calls
10:00 Check Voice Mail
10:15
11:00
11:30 Drive to Lunch
Check Voice Mail

The Source for Executive Function Disorders 59 Copyright © 2003 LinguiSystems, Inc.
 Time Management

12:00 Lunch at Main Street

Get Gasoline
1:00 Drive Back from Lunch
1:30 Check E-mail
Afternoon Phone Calls
2:00 Check Voice Mail
2:15
3:00
4:00 Check E-Mail
4:15
5:00 Organize for Tomorrow
Check Voice Mail
5:30 Drive to Meeting
6:00 Meeting at Club
7:00 Drive Home
7:30 Dinner

Documentation:
➤ What percentage of routines were written into the schedule on a regular
basis?
➤ How many of these were completed as scheduled, rescheduled, or abandoned?
➤ What prevented the patient from completing a routine task at the routine
time? Was there a pattern to the errors?

Phase 6: To-Do Lists

To-do lists can prove to be an invaluable
aspect to the patient’s time organization. Helpful Hint: Break the habit of writing on numerous
During the morning schedule review, the “sticky notes.” The to-do list needs to be
patient should determine what tasks need in the organizational system, not on a
to be completed during the day. This must separate sheet of paper.
be comprehensive and include all required
daily events, including tasks at home and at work, as well as social activities.
Some actions on the list must be done at a specific time and should be scheduled
to reflect that time commitment. Others may be more loose and can be listed along
the side or at the bottom.

To Do List:
Errands: ❏ Drop off clothes at dry cleaners
❏ Go to drugstore
Work: ❏ Finish project and turn in
Misc. ❏ Meeting at club tonight

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 Time Management

OCTOBER 3
6:00 Wake and Shower
7:00 Eat Breakfast
7:30 Leave for Work
8:00 Bring Clothes for Dry Cleaners to Work
Planning
Check Voice Mail
Check E-mail
8:30 Meet with Bob
9:00 Morning Phone Calls
10:00 Confirm Meeting Tonight
Check Voice Mail
10:15
11:00
11:30 Drive to Lunch
Check Voice Mail
12:00 Lunch at Main Street
Get Gasoline
1:00 Drive Back from Lunch
1:30 Check E-mail
Afternoon Phone Calls
2:00 Check Voice Mail
2:15
3:00
4:00 Check E-Mail
4:15
5:00 Project Due
Organize for Tomorrow
Check Voice Mail
5:30 Drive to Meeting
6:00 Drop Off Clothes at Dry Cleaners
Go to Drugstore
Meeting at Club
7:00 Drive Home
7:30 Dinner

Documentation:
➤ Did the patient create a daily to-do list?
➤ Was the list all-encompassing?
➤ In hindsight, how many items failed to make the list yet needed to be done?
➤ Were there particular items or categories that the patient always forgot?

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 Time Management

Phase 7: Prioritizing
At this point, the patient has recorded all scheduled events in the organizational
system, established a daily to-do list, and determined the time necessary to complete
each event. Rarely, however, are the number of hours in the day compatible with
the amount to be completed. Patients with executive function disorders tend to be
haphazard in deciding which tasks to complete and which to let go. Patients with
frontal lobe dysfunction have difficulty filtering what is and what is not a priority.
Determination of priorities must be based on a structured priority system.

Have the patient establish the priorities for each day by considering a priority par-
adigm such as the following:

Pressing Not Pressing

Significant Tasks which are both crucial Tasks which are crucial to
to complete and have a complete but do not have a
deadline deadline
Not Significant Tasks which may not be Tasks which are neither
crucial but must be done crucial nor under time
within a time constraint constraints

Another way to consider priorities is to apply a penalty/bonus paradigm.

High Bonus Low Bonus

Penalty Tasks that render benefit Tasks that render little
and involve punishment from benefit and involve punish-
others if not completed ment from others if not
completed
No Penalty/ Tasks that render benefit Tasks that render little
Reward and reward from others benefit but induce rewards
when completed from others when completed

Patients with difficulties in time management often work exclusively in the pressing/
significant box or the penalty boxes. Due to their inability to effectively manage their
time, they do not deal with a task until it becomes driven by a deadline or a crisis.
Because they are always operating in these boxes, they rarely find time for events
that are not pressing or significant.

Ask the patient to identify the most important item on his or her to-do list for each
day and physically mark it with #1 on the daily calendar. This is an item that must
be completed that day. Next, have the patient
identify the #2 item, a task which would be Helpful Hint: Too many priorities, by definition, are
nice to complete but is not necessary, and not priorities. There should never be
mark that on the calendar. more than 2-3 #1 items in a day.

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 Time Management

To-Do List:
Errands: ❏ Drop off clothes at dry cleaners
❏ Go to drugstore
Work: ❏ Finish project and turn in
Misc. ❏ Meeting at club tonight

OCTOBER 3
6:00 Wake and Shower
7:00 Eat Breakfast
7:30 Leave for Work
8:00 Bring Clothes for Dry Cleaners to Work
Planning
Check Voice Mail
Check E-mail
8:30 #1 Meet with Bob
9:00 Morning Phone Calls
10:00 Confirm Meeting Tonight
Check Voice Mail
10:15
11:00
11:30 Drive to Lunch
Check Voice Mail
12:00 Lunch at Main Street
Get Gasoline
1:00 Drive Back from Lunch
1:30 Check E-mail
Afternoon Phone Calls
2:00 Check Voice Mail
2:15
3:00
4:00 Check E-Mail
4:15
5:00 #1 Project Due
Organize for Tomorrow
Check Voice Mail
5:30 Drive to Meeting
6:00 Drop Off Clothes at Dry Cleaners
#2 Go to Drugstore
Meeting at Club
7:00 Drive Home
7:30 Dinner

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 Time Management

Documentation:
➤ Did the patient establish an appropriate number of priorities for the day?
➤ Did he or she use a paradigm to determine the priority, carefully considering
all aspects?
➤ Into which box do most of the tasks fall?
➤ Were the items established as #1 priority consistently being completed?

Phase 8: Review Times Three

Writing down the information is only half of the equation. Looking at what was
written down is the other half. The patient should review and study the time
schedule at least three times per day.

The first opportunity is in the morning

Helpful Hint: Correlating review times with meal
when the patient plans the day. Review
times is an effective way to target 3
will occur again midday, with the purpose
review periods in the day.
of examining the events that have occurred
and anticipating the remaining activities.
Lastly, the schedule will be reviewed in the evening to both recall the current day’s
events and to look toward the following day.

Write a large 1, 2, and 3 on each day’s page that correspond to a morning (1), mid-
day (2), and evening (3) review of the day’s events. Require the patient to cross off
the number to each review as it is accomplished. If the patient has significant dif-
ficulty remembering to check the organizational system, attach a small clip-on
alarm that is set to go off at determined times.

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 Time Management

1 2 3
OCTOBER 3
6:00 Wake and Shower
7:00 Eat Breakfast
7:30 Leave for Work
8:00 Bring Clothes for Dry Cleaners to Work
Planning + Review Period #1
Check Voice Mail
Check E-mail
8:30 #1 Meet with Bob
9:00 Morning Phone Calls
10:00 Confirm Meeting Tonight
Check Voice Mail
10:15
11:00
11:30 Drive to Lunch
Check Voice Mail
Review Period #2
12:00 Lunch at Main Street
Get Gasoline
1:00 Drive Back from Lunch
1:30 Check E-mail
Afternoon Phone Calls
2:00 Check Voice Mail
2:15
3:00
4:00 Check E-Mail
4:15
5:00 #1 Project Due
Organize for Tomorrow + Review Period #3
Check Voice Mail
5:30 Drive to Meeting
6:00 Drop Off Clothes at Dry Cleaners
#2 Go to Drugstore
Meeting at Club
7:00 Drive Home
7:30 Dinner

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 Time Management

Documentation:
➤ How frequently did the patient review the schedule? Three times per day?
➤ What percentage was the patient averaging during this treatment period?
➤ What kept the patient from being successful in checking the calendar?
➤ Was there a pattern to the missed reviews?

Phase 9: Feed Forward

Even if the patient is appropriately scheduling his or her day within the time con-
straints and with appropriate priorities, there will still be some items that are not
accomplished. Where do these items go? Individuals with executive function dis-
orders often abandon tasks if they are not completed at the time they were sched-
uled. At the end of each day, the patient should review the schedule for tasks that
were not completed. Each incomplete task should be evaluated as follows:

Opportunity Missed: The event was a one-time opportunity. By not

doing it, the chance was missed and the event is
over.
Feed Forward: The scheduled item could be done at another time.
Immediately schedule this event forward in the cal-
endar system.
Store for Later: The item remains interesting but a definitive time
to complete it is not necessary. Log this in the
Master List (see Phase 12 on page 70) for future
reference.

Documentation:
➤ How many items were not completed?
➤ Were they priorities?
➤ Of the items on the daily to-do list that were not completed, how many were
appropriately dealt with in terms of rescheduling or entering elsewhere?

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 Time Management

1 2 3
OCTOBER 3
6:00 Wake and Shower
7:00 Eat Breakfast
7:30 Leave for Work
8:00 Bring Clothes for Dry Cleaners to Work
Planning + Review Period #1
Check Voice Mail
Check E-mail
8:30 #1 Meet with Bob
9:00 Morning Phone Calls
10:00 Confirm Meeting Tonight
Check Voice Mail
10:15
11:00
11:30 Drive to Lunch
Check Voice Mail
Review Period #2
12:00 Lunch at Main Street
Get Gasoline
1:00 Drive Back from Lunch
1:30 Check E-mail
Afternoon Phone Calls
2:00 Check Voice Mail
2:15
3:00
4:00 Check E-Mail
4:15
5:00 #1 Project Due
Organize for Tomorrow + Review Period #3
Check Voice Mail
5:30 Drive to Meeting
6:00 Drop Off Clothes at Dry Cleaners (Missed — Move to Friday)
#2 Go to Drugstore
Meeting at Club (Missed — Attend Next Month)
7:00 Drive Home
7:30 Dinner

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 Time Management

Phase 10: Anticipation

Once mastery of a single day of scheduled events is complete, the patient should
move toward anticipation of more than one day. Patients with executive function
disorders are often working minute to minute, just trying to keep their heads
above water. They have no time or forethought to consider a report due on Friday
until Thursday.

In this phase of therapy, patients need to anticipate full weeks of schedules at a

time. Consider the number and type of appointments for each day, the amount of
time needed to complete projects, and the amount of time available. A patient may
need to have snacks for her son’s 30 classmates for Thursday but have a full day
of activities scheduled for Wednesday. The only opportunity to shop is on Tuesday
morning. The patient with frontal lobe dysfunction isn’t able to recognize this
dilemma until Wednesday night when she checks the next day’s schedule. Assist
the patient in learning how to start at the end date/deadline for the project and
work back to determine when the project fits in.

Documentation:
➤ Can the patient develop weekly schedules and weekly to-do lists?
➤ How many activities during the week did the patient feel he or she had to deal
with abruptly?

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 Time Management

1 2 3
OCTOBER 3
6:00 Wake and Shower
7:00 Eat Breakfast
7:30 Leave for Work
8:00 Bring Clothes for Dry Cleaners to Work
Planning + Review Period #1
Check Voice Mail
Check E-mail
8:30 #1 Meet with Bob
9:00 Morning Phone Calls
10:00 Confirm Meeting Tonight
Check Voice Mail
10:15
11:00
11:30 Drive to Lunch
Check Voice Mail
Review Period #2
12:00 Lunch at Main Street
Get Gasoline
1:00 Drive Back from Lunch
1:30 Check E-mail
Afternoon Phone Calls
Collect Information for Report Due Next Monday
2:00 Check Voice Mail
2:15
3:00
4:00 Check E-Mail
4:15
5:00 #1 Project Due
Organize for Tomorrow + Review Period #3
Check Voice Mail
5:30 Drive to Meeting
6:00 Drop Off Clothes at Dry Cleaners (Missed — Move to Friday) Take Suit for
Tuesday Meeting
#2 Go to Drugstore
Meeting at Club (Missed — Attend Next Month)
7:00 Drive Home
7:30 Dinner

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 Time Management

Phase 11: Expect the Unexpected

“The best laid plans . . . .” Wonderfully modeled time schedules rarely go as
planned. A schedule can be altered for so many reasons and it is impossible to
anticipate all situations. It is, however, possible to anticipate some. In looking at
the daily schedule, the patient should ask, “What could possibly go wrong?”
Planning ahead is highly problematic for the patient with executive function dis-
orders, and the repair phase is discussed in more detail in other sections of this
book (see page 155). For treatment purposes, take a given day in the patient’s
schedule and contrive an unexpected change. Have the patient describe the pos-
sible solutions and schedule necessary changes.

For example, at 3:00 the patient’s schedule reads, “Pick up kids at school and drive
to piano lessons.” Suggest an unexpected situation such as, “When you go outside,
the car tire is flat.” Then ask, “How does this impact the rest of the schedule and
how will you reschedule?”

Documentation:
➤ How flexible was the patient in both contrived and actual schedule changes?
➤ How completely did the patient deal with the items in conflict?
➤ How many tasks did the patient forget when a schedule change occurred?

Phase 12: The Master List

One dilemma, not unique to executive function disorders, is balancing short-term
to long-term tasks and goals. Short-term activities, those that can be completed
within a week, should be listed on daily to-do lists. However, most of us have activ-
ities we would like to accomplish, yet they do not fit into a specific time frame.
These ideas should go onto a “master list.” This is a single, continuous, dynamic
list that provides the patient with a place to “keep things in mind.” It is not intend-
ed as an action list, so there is no need to limit the items on this list or to catego-
rize them. The list may be long, and it may stay that way. Instruct the patient to
frequently re-examine the list, eliminate items that are no longer interesting or
necessary, add items as they come up, and group similar items.

During weekly planning, have the patient review the master list. Is there an
opportunity to fit one of these items into the week?

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 Time Management

Master List
Work:
❏ Investigate new tax program.
❏ Develop new review form.
❏ Take course in technology.
❏ Rearrange office space.

Home:
❏ Look for new couch.
❏ Purchase new bookshelf.
❏ Organize closet.
❏ Have dinner with the Smiths.

Documentation:
➤ Did the patient add items to the master list on an ongoing basis?
➤ Were there items on the daily to-do list that would be more appropriate for
the master list and vice versa?
➤ How frequently did the patient review the master list?

Sticking to a rigid time schedule may be difficult for some patients whose style is
more carefree. If the patient is consistently missing appointments or deadlines,
has difficulty scheduling daily tasks, complains of constantly being behind or hur-
ried, or is generally disorganized, a time schedule is essential. It is easy to back
off of some of the rigidity as the patient proves ability.

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 Time Estimation Worksheet

Name: Date:

Make a list of various tasks you need to accomplish (getting dressed, making phone calls, driving to
appointments, shopping, etc.). Estimate the amount of time you think it will take to complete each task.
After you have completed a task, write the actual amount of time you spent doing it.

Task Estimate Actual

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 Time Available Equation

Name: Date:

Time Available

Write daily tasks on the lines below and the amount of time (in hours) tasks take in the shaded
boxes. Continue subtracting from the subtotals to calculate the time available every day outside
of normal tasks and routines.

hours in a (circle one) day work week

— ____________________________________________________________________

subtotal

— ____________________________________________________________________

subtotal

— ____________________________________________________________________

subtotal

— _____________________________________________________________________

subtotal

— _____________________________________________________________________

Total Hours Available

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 Treatment

Attention

D eficits in attention are common following frontal lobe damage.

For the purpose of this manual, we will consider five compo-
nents of attention:
➤ Focused Attention is the ability to respond discretely to partic-
ular visual, auditory or tactile stimuli.
➤ Sustained Attention is the ability to sustain a steady response
during continuous activity. It incorporates the notion of vigilance
and concentration.
➤ Selective Attention is the ability to maintain attention in the
face of distracting or competing stimuli. These distractions may
be either external or internal.
➤ Alternating Attention is the capacity for mental flexibility that
allows the shift of focus between tasks.
➤ Divided Attention is the ability to respond simultaneously to
multiple tasks or to do more than one activity at a time.

Picture attention as an electrical fuse box.

2 3 4 Lots of current travels in and out without dif-
ficulty; however, once the electrical circuit
1 5 approaches maximum capacity, it does not
take much for it to “blow.” Whether the input
is from switching on a small light or a huge
microwave may not matter . . . too much is too
12 Frontal Lobe 6 much. And once the circuits blow, it takes
time to reset everything and get back to nor-
mal. The key is to instruct patients to oper-
11 7 ate below maximum and avoid having the cir-
cuits blow.

10 9 8

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 Attention

With normal function, the frontal lobe will

organize/store the details of jobs 1-4 and 6-
12 while it focuses on job 5. It can set down 2 3 4
job 5 and pick up job 8 and focus on it, and
so on. It can add job 13 or 14, or when fin- 1 5
ished with job 5, plug in a new job 5.

The injured frontal lobe can’t organize or sep-

arate the details of jobs 1-12. Each seems of 12 Frontal Lobe 6
equal importance at all times. If the person
tries to focus on job 5, every other job vies for
equal time and attention. There is so much 11 7
input it is impossible to focus. If the frontal
lobe is on overload, it cannot absorb anything 10 9 8
else. It shuts down and refuses to accept any
more input and nothing gets done.

The frontal lobe can deal magnificently with

one job at a time, on a linear level, seeing each job to its completion before adding
another job.

Frontal Lobe 1 2 3 4

5 6 7 8

9 10 11 12

In order to be successful in the remediation and/or the compensations for attention

deficits, the patient needs to be knowledgeable about the types of attention.
➤ Begin by instructing the patient in definitions and examples of each type of
attention.
➤ As the patient is learning types of attention, have him or her discern what type
of attention is required to successfully complete a variety of daily tasks.

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 Attention

Task Required attention levels

Reading the paper Sustained
Reading the paper with the radio on Sustained + Selective
Reading the paper with the radio on Sustained + Divided
and listening for the weather report
Reading the paper with the radio on Sustained + Alternating
and listening to a breaking new story
Talking on the phone Sustained
Talking on the phone with others Sustained + Selective
in the room
Talking on the phone with others Sustained + Alternating
asking you questions
Talking on the phone while preparing Sustained + Divided
a can of soup

Have patients use the Required Attention Levels chart on page 98 to keep track
of tasks and types of attention levels over several days. If the patient works outside
of the home, he or she should complete the chart for work activities also. Ask the
patient to identify which activities were particularly difficult and which were simple.
In analyzing this chart, the patient will become more aware of the attentional
demands of the activities participated in daily. This knowledge can change “I can’t
do it!” to “I have trouble concentrating for long periods of time.” By recognizing the
specific demands of the activity, employing appropriate strategies to maximize abili-
ties becomes more obvious.

As with all treatment tasks, the more functional and “everyday” the activity the bet-
ter. Use specific drill activities only as supplements to daily activities.

Focused Attention
This level of attention is a lower-level ability of discrimination and not typically
impaired with higher-level disorders such as executive function disorders.

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 Attention

Sustained Attention
Sustained attention is the ability to maintain attention to the task for a long enough
period of time to complete the task. Throughout the day, a person needs adequate
sustained attention to read the paper, drive a car, or complete a phone conversation.

There are several variables to consider in maintaining attention to a task.

➤ Difficulty of the task: It is far more difficult to sustain attention to a difficult
activity as compared to a more simplistic activity. Complexity can be of either
a physical or mental nature.
➤ Familiarity: It is generally more difficult to sustain attention to an activity
that is novel; however, extremely familiar tasks may become mundane and
therefore challenging to sustained attention.
➤ Enjoyment: It is easier to maintain attention to a task that is fun to do as com-
pared to one that is not enjoyable.

It is important to have a realistic understanding of how long a task can engage atten-
tion. Even a simple, familiar, enjoyable activity can only capture attention for
approximately 20 minutes before a small break is needed. Often, 15-30 seconds can
be enough of a pause before returning to the task. Difficulty arises when persisting
at a task long after attention has waned and/or taking too long to return to the task
after a break.

The most effective strategy to compensate for reduced sustained attention is to pre-
determine the length of concentration time on a task and the length and fashion of
the break. Attention should be controlled, not controlling.

Target activities that the patient participates in frequently—simple and complex,

familiar and novel, enjoyable and boring. Guide the patient through completing the
Activity Worksheet on page 99 to identify the activity, predetermine the concen-
tration period, the break period, and the break activity.

Next, have the patient actually participate in these activities while timing/regulating
the concentration time and break time. Upon completion, identify if this particular
equation was successful and what alterations should be made. Ask the patient to
continue with this activity until success is frequent.

An example of a completed Activity Worksheet is shown on the next page.

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 Attention

Concentration Break Time

Activity Time & Activity Was It Successful? Why? Modifications
Reading the 3 paragraphs 30 seconds Yes Increase to 5 paragraphs.
newspaper Look up from the paper
and review the main point.
Reading a 5 minutes 30 seconds No; didn’t recall details Decrease time to 4 minutes.
book Look up from the book and of the last 2 paragraphs.
review the plot of the story.
Listening to 20 minutes 30 seconds Yes Continue; do not increase.
a lecture Look up, put down pen,
take a sip of water, and
count to 30.
Watching a 30 minutes 30 seconds No; didn’t follow the plot Decrease watching time to
movie at Pause movie, get up, and of the movie. 20 minutes.
home stretch.
Cleaning the 30 minutes 5 minutes No; started watching TV Keep TV off and set timer/
house Stop, sit down, and have a during break and didn’t alarm for 5 minutes during
drink. return to cleaning. break.
Paying bills 15 minutes 1 minute No; became distracted and Use alarm or timer to
Get up and walk around didn’t return to bills for remind when break is
the desk. 30 minutes. over.

➤ Begin this chart during treatment sessions with the patient identifying a real-
life activity and the therapist determining the times and break activities.
➤ Move toward the patient developing the entire chart during sessions using
treatment tasks.
➤ Lastly, move toward having the patient use this chart at home, and then review
the findings during treatment.

In addition to managing reduced sustained

Helpful Hint: Completing even long, complicated attention via compensations, patients can
tasks is possible when they are work on both clinical and functional tasks to
broken down into small, manageable increase the length of time they are able to
increments. Kitchen timers are inex- attend. Highly structured, systematic
pensive, easily-available tools to sig- increases of the amount of time a patient
nal break and return times. persists with a task can be successful in
increasing the overall time period a patient is
able to attend to an action. Real-life activities are best to use. Have the patient prac-
tice reading, paying bills, typing, or writing during the treatment session and home-
work for the pure activity of practice. Systematically increase the attention times.
Several clinical tasks for improving sustained attention are described on the follow-
ing pages.

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 Attention

➤ Cancellation Tasks: These simple tasks provide excellent clinical tasks for
attention. The Cancellation Activities on pages 100-115 consist of a number
of visual cancellation tasks that use shapes, numbers, letters, etc.
Introducing the Task:
• “Here is a page of arrows pointing in various directions. Make a slash
through each arrow that is pointing up. I’ll ask you to stop in about 1
minute.”

Manipulating the Difficulty of the Task:

• Manipulate the length of time the task is continued.
• Manipulate the frequency with which the target appears.
• Manipulate the visual difficulty of the task (e.g., print size).

➤ Math Equations: For those who enjoy math, a page of simple math equations
such as those on pages 116-121 can be used for sustained attention tasks.
• Have the patient perform the equations for specified amounts of time. Here
are some examples of simple math equations included in the activities:
1 2 4 4 3 1 6 7
+9 +7 +2 +6 +2 +7 +5 +7
10 9 6 10 5 8 11 14

Introducing the Task:

• “Here is a page of single-digit addition problems. I’d like you to solve them.
I’ll tell you to stop in about 1 minute.”
• “Here is a page of single-digit addition problems. I’d like you to solve them.
I’ll tell you to stop in about 5 minutes.”
• Here is a page of 3-digit addition problems. I’d like you to solve them. I’ll tell
you to stop in about 1 minute.”

Manipulating the Difficulty of the Task:

• Manipulate the length of time the patient persists with the task.
• Manipulate the difficulty of the math problems.
• Manipulate the visual stimulation of the page, (e.g., print size).

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 Attention

➤ Auditory Attention: In these tasks, the patient listens as you read a list of
random words, names, or numbers aloud. Have the patient make a tally mark
whenever he or she hears the target word, name, or number. Use the Auditory
Attention activities on pages 122-132 for this task.
Introducing the Task:
• “Here is a blank sheet of paper. I am going to read a random list of names at
a fast pace. Every time you hear the name Mary I want you to make a tally
mark. You will do this for about 1 minute.”
Mary Joan Mary Fred Alice Bob Susan
Betty Mary Lauren Martha Mary Sally George

• “Here is a blank sheet of paper. I am going to read a random list of numbers.

I would like you to make a tally mark every time you hear a number con-
taining a 7. You will do this for about 2 minutes.”
121 367 481 167 652 841 925 763 467 208
325 947 881 621 371 444 973 602 187 134

Manipulating the Difficulty of the Task:

• Manipulate the length of time the patient persists with the task.
• Manipulate the speed of presentation.
• Manipulate the complexity of the stimuli.
• Manipulate the complexity of the target:
✔ “Make a mark every time you hear a number that ends in 7.”
✔ “Make a mark every time you hear a number that is greater than 3.”
✔ “Make a mark every time you hear a word that begins with a T.”
✔ “Make a mark every time you hear a word that begins with a vowel.”

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 Attention

Selective Attention
Selective attention is the ability to concentrate on the target task while ignoring dis-
tractions. At a basic level, it requires selecting one stimulus to pay attention to from
a group or a series, like finding certain letters in a word search or listening for a spe-
cific highway during a traffic report. At a higher level, it is trying to follow a con-
versation and to ignore another conversation taking place nearby. Distractions may
be external (TV or radio) or internal (hunger). During the day, counting change in a
loud grocery store, talking on the phone with family members talking in the same
room, or participating in a meeting following only 2 hours sleep the night before are
all examples of selective attention.

There are several variables to consider in keeping attention focused on the target
while ignoring the distractions:
➤ Difficulty of the task: Although at first thought, a simple target task would
appear easiest, tasks that are too simple or mindless are often the easiest to
drift from.
➤ Familiarity: It is easier to attend to a familiar task. Conversely, it is more dif-
ficult to tune out a familiar task in lieu of concentrating on the less familiar tar-
get activity.
➤ Enjoyment: It is easier to tune out dis-
tractions when the target task is pleas- Helpful Hint: Silence is not always golden. For
urable. Conversely, it is more difficult to many, a completely silent environ-
tune out a distraction that is preferable ment greatly increases internal dis-
to the target task. tractions. Activity or noise in the
➤ Intensity of the distraction: The background can become white noise
amount of effort needed to tune out a and actually enhance some patients’
distraction often leaves little left for the ability to attend to the task at hand.
target task.

The obvious compensation for reductions in selective attention is to reduce the dis-
tractions. To do this, the patient must become keenly aware of what is occurring con-
currently with the target task.

Begin by asking the patient to complete the Distractions Worksheet on page 133
during the treatment session using real-life scenarios. An example of a completed
chart is on the next page.

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 Attention

Task Distractions Present Modifications

Driving to work • Radio on • Turn off radio.

• Talking on phone • Limit phone calls.
• Busy highway • Consider an alternate route.
• Hot • Take off coat.
• Hungry • Eat breakfast.

Writing a letter • Phone ringing • Turn on voice mail.

• Radio on news station • Change to quiet music.
• Poor quality pen • Have all supplies before writing
letter.
• Thinking of another letter that • Schedule a time to write second
needs to be written letter; keep note card handy for
ideas.

Making dinner • TV on • Turn off TV or mute the volume.

• Talking on phone • Make calls before or after
preparation time.
• Children asking questions about • Schedule time before or after
homework dinner for homework help.
• Stove and microwave both active • Use timers to keep varied finish
times on track.
• Hungry • Have a small snack.

Attending a meeting • Noisy air conditioner • Select a seat far away from
blower.
• Thinking about new ideas • Keep note cards handy to make
stimulated from discussion memos to self.
• Sleepy • Sip on water; change meeting
time.

➤ Begin this chart during treatment sessions with the patient identifying a real-
life activity and the therapist determining the distractions and modifications.
➤ Move toward the patient developing the entire chart during sessions.
➤ Lastly, move toward having the patient use this chart at home and then review
the findings during treatment.

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 Attention

Ultimately, the patient must become aware of Helpful Hints: • Have the patient use a sign on
the distractions that may be preventing com- the door or on the desk at work to
pletion of the task at hand and become aware communicate to people when not
of appropriate modifications to both the target to disturb him or her.
task and the competing tasks, allowing for
success. • • Remember, attention is cumulative.
Do not forget to incorporate the
In addition to managing reduced sustained patient’s limits of sustained atten-
attention via compensations, patients can tion into his or her plans for selec-
work on both clinical and functional tasks to tive attention.
increase their ability to tolerate distractions.
Highly structured, systematic increases of the amount and intensity of distractions
can be successful. Have the patient perform reading, paying bills, typing, writing or
other functional tasks during the treatment session and for homework for the pure
activity of practice. Systematically manipulate these variables:
• difficulty of the task
• familiarity of the task
• enjoyment of the target task
• enjoyment of the distraction
• intensity of the distraction

For example, turn on a news radio channel or a TV news channel. Ask the patient
to listen carefully to a story and write down a few facts about the story. As the
patient is listening, read aloud a competing story from the newspaper. Here are
some ways to further manipulate the difficulty of this task:
• Manipulate the interest level of the target story.
• Manipulate the interest level of the competing story.
• Manipulate the proximity/intensity of the target story.
• Manipulate the proximity/intensity of the competing story.

As with all treatment, the more “true to life” the treatment activity, the easier the
generalization to the patient’s life. That said, there is benefit to nonfunctional, clin-
ical tasks; however, they should never be used in exclusion.

➤ Cancellation Tasks: The Cancellation Activities on pages 100-115 provide

excellent clinical tasks for selective attention. Select a target letter, number, or
shape and have the patient scan the page and mark off the target every time it
appears while there is a simultaneous distraction, such as a radio or TV playing
in the background.

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Manipulating the Difficulty of the Task:

• Manipulate the variables described in the Sustained Attention section
(length of time the task is continued, frequency with which the target
appears, visual difficulty of the task).
• Manipulate the intensity of the distracting stimuli.
• Manipulate the interest level of the distracting stimuli.
• Manipulate the number of distractions.

You can also use everyday reading materials, such as newspapers and maga-
zines, to present a cancellation task. Here are some ways to introduce that type
of activity incorporating various types and intensities of distractions:
• “Here is the newspaper. I’d like you to cross off the letter t every time it
appears in this article. While you are doing this, I’ll have some quiet music
on in the background. Ignore the music and work on the letters. You’ll do
this for about 1 minute.”
• “Here is the newspaper. I’d like you to cross off the letter t every time it
appears in this article. I’m going to have on some loud rock music in the back-
ground. Ignore the music and work on the letters. You’ll do this for about 1
minute.”
• “Here is the newspaper. I’d like you to cross off the letter t every time it
appears in this article. We’re going to do this in the cafeteria, and I’m going
to be talking with someone next to you. Ignore these distractions and con-
centrate on the letters. You’ll do this for about 1 minute.”

➤ Math Equations: For those who enjoy math, a page of simple math equations,
such as the ones on pages 116-121, can be used for selective attention tasks.
Have the patient perform the equations for specified amounts of time in the
presence of competing stimuli, such as a conversation in the background.

Manipulating the Difficulty of the Task:

• Manipulate the length of time the patient persists with the task.
• Manipulate the difficulty of the math problems.
• Manipulate the visual stimulation of the page (e.g., print size).
• Manipulate the intensity of the distraction.
• Manipulate the interest of the distraction.
• Manipulate the number of distractions.

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➤ Auditory Selective Attention: The Auditory Attention activities on pages

122-132 provide excellent clinical tasks for selective attention. These simple
tasks can be easily manipulated to address attention issues. Read a list of ran-
dom names or numbers aloud to the patient. Have the patient make a tally
mark whenever the target letter is read.

Introducing the Task:

• “Here is a blank sheet of paper. I am going to read a random list of words. I
would like you to make a tally mark every time you hear the word for. At the
same time, I will have some soft music on in the background. Concentrate on
my voice and ignore the music. You will do this for about 1 minute.”
• “Here is a blank sheet of paper. I am going to read a random list of names at
a fast pace. I’m also going to have the radio playing on the news station.
Every time you hear the name Bob, I want you to make a tally mark. Ignore
the radio and concentrate on my voice. You will do this for about 1 minute.”
• “Here is a blank sheet of paper. I am going to read a random list of numbers.
I would like you to make a tally mark every time you hear a number con-
taining a 7. We’re going to sit in a corner in the waiting room to do this.
Ignore the people and voices and concentrate on my voice. You will do this
for about 2 minutes.”
Have the patient perform the task for specified amounts of time and vary the
task by reading aloud words, numbers, or names.

Manipulating the Difficulty of the Task:

• Manipulate the length of time the patient persists with the task.
• Manipulate the speed of presentation.
• Manipulate the intensity of the competing stimuli.
• Manipulate the interest level of the competing stimuli.
• Manipulate the complexity of the target.
✔ “Make a mark every time you hear
a number that ends in 7.” Helpful Hint: Most speech-language pathology
✔ “Make a mark every time you hear offices provide ideal conditions. The
a number that is greater than 3.” room is quiet, well-lit, and tempera-
✔ “Make a mark every time you hear ture-controlled. Taking treatment
a word that begins with a T.” outside the office is a quick way to
✔ “Make a mark every time you hear manipulate the level of distraction.
a word that begins with a vowel.” Try having the treatment session in
the waiting room, physical therapy
gym, or even the local coffee house.

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 Attention

➤ Visual Selective Attention: Ask the patient to read aloud a page of words
with visual foils, such as the ones presented on pages 133-137. For example, the
words big and little appear in both large and small print. Ask the patient to read
the word, ignoring the size of the print. Conversely, ask the patient to state the
size of the print, inhibiting the desire to read the word. Activities are also pro-
vided to do similar activities with the words skinny/fat, cursive/print, and
bold/light.

Introducing the Task:

• “Look at the words on this page. Scan word by word, saying big for every word
printed in all capital letters and little for all words printed in lowercase.”
BIG LITTLE big little LITTLE big
BIG LITTLE big LITTLE big little
little big BIG LITTLE big BIG

Answer:
big big little little big little
big big little big little little
little little big big little big

Alternating Attention
The ability to fluctuate attention between two or more activities is called alternating
attention. This skill is utilized frequently in daily activities, such as making dinner,
stopping to answer the door, then returning to cooking; balancing the checkbook,
stopping to put new batteries in the calculator, and then returning to the checkbook;
or listening to a business meeting, stopping to answer a phone call, then returning to
the meeting.

There are several variables of difficulty that contribute to alternating attention abilities.
➤ Difficulty of each task: It is easier to alternate between simple tasks.
➤ Familiarity of each task: It is easier to alternate between known tasks.
➤ Enjoyment: It is easier to alternate between enjoyable tasks.
➤ Number of tasks alternating between: The more tasks involved, the more
difficult.
➤ Length of time allowed working on each task: There is a critical point on
both ends of the time spectrum. Spending too much time on one task makes it
easy to forget to return to the other(s). Spending too little time on each task
makes things confusing.

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 Attention

➤ Length of time between tasks: Again, there is a critical point at both ends.
Spending too much time between tasks results in a loss of sustained attention.
Spending too little time between tasks becomes confusing.
➤ Length of time to persist with these tasks: It is much easier to alternate
between two simple, fun tasks for a few minutes than for an hour.

To assist patients in becoming aware of the number of tasks they function between,
ask them to complete the Task Combination Worksheet on page 138. Here is an
example of a completed worksheet:

Appropriate
Tasks Times Reminders
Combinations
Do laundry Do laundry + cook 10 minutes to start wash.
dinner.
Begin dinner for 30 min- Use kitchen timer.
Cook dinner
utes change laundry Use pencil to mark your
for 10 minutes. place in the recipe.
Return to dinner for 30 Use kitchen timer.
minutes change laundry Use pencil to mark your
for 10 minutes. place in the recipe.
Help with homework Homework help cannot be
combined with others.

➤ Ask the patient to generate a list of activities for the day. These will include
daily and routinely scheduled tasks, along with particular activities for that day.
➤ Work with the patient to determine which of these tasks need to be completed
in isolation and which can be alternated between.
➤ Considering the difficulty, familiarity,
and enjoyment of each task, predeter- Helpful Hint: Remember that attention is cumula-
mine the number of tasks that can be tive. Do not forget to incorporate the
involved, the length of time the patient patient’s limits of sustained and
will spend on each task, the time selective attention into the plan.
between tasks, and the total time this
alternating will continue.
➤ Additionally, determine a reminder method to trigger when to end one task and
begin the next. This may be an alarm clock, timer, watch alarm, phone call, etc.

In addition to managing reductions in alternating attention via compensations,

patients can work on both clinical and functional tasks to increase their ability to
alternate between tasks. Highly structured, systematic increases of the amount, dif-
ficulty, and time constraints of tasks can be successful. Have the patient perform a
variety of activities during the treatment session and homework for the pure activi-
ty of practice.

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 Attention

Systematically manipulate these variables:

• Difficulty of each task: It is easier to alternate between simple, routine tasks.
• Familiarity of each task: It is easier to alternate between familiar tasks.
• Enjoyment: It is easier to alternate between pleasant tasks.
• Number of tasks attention is divided between: Fewer tasks are
easier.
• Length of time the patient must persist with each task: Too little time
with each task is confusing, but too much time can result in ignoring the addi-
tional tasks.
• Length of time allowed between tasks: Again, too little transition time can
become confusing, but too much transition time can result in failing to begin or
return to the other task.

➤ Cancellation Tasks: The Cancellation Activities on pages 100-115 provide

excellent clinical tasks for alternating attention. These simple tasks can be eas-
ily manipulated to address various attention issues.

Introducing the Task:

• Have the patient cross off the same target for 5 lines (up arrow). At the 6th
line ask the patient to cross off a different target for the next 5 lines (down
arrow). At the 10th line have the patient return to the original target, etc.

Manipulating the Task:

• Manipulate the variables as described in the Sustained Attention section.
• Manipulate how frequently the patient is required to switch targets. For
example, instead of switching targets every 5 lines, have the patient change
every 3 lines, and eventually switching every line.
• Manipulate the pattern or predictability of changing to a different target. For
example, during the scanning task, randomly say “switch,” at which time the
patient must switch to a different target.

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 Attention

• Manipulate how many target stimuli the patient is alternating between. For
example, he or she may begin by scanning for 1 target (crossing off only the
“up” arrows) and progress to scanning for 3 targets (crossing off the “up,”
“down,” and “left” arrows).

➤ Math Equations: For those who enjoy math, a page of simple math equations
such as those on pages 139-141 can be used for alternating attention tasks.
Alternating the function of the math equation is one way to get the patient to
alternate attention.
Manipulating the Task:
• Manipulate the variables described in the Sustained Attention section.
• Manipulate how frequently the patient is required to switch targets. For
example, the activity on page 139 provides the patient with alternating lines
of addition and subtraction problems.
• Manipulate the pattern or predictability of changing to a different target. For
example, the activity on page 140 presents lines of mixed addition and sub-
traction problems.
• Manipulate how many functions the patient is required to alternate between.
For example, the activity on page 141 presents lines of mixed addition, sub-
traction, and multiplication problems.

The key to improving high-level alternating attention is to systematically increase the

variables regardless of the clinical or functional tasks patients are engaged in doing.
• Begin with two simple, enjoyable tasks. Provide adequate time to “get into”
each task, for example 3-5 minutes. Provide a 30-second break between
tasks. Continue with these two tasks for 2-3 cycles.
• Increase the difficulty relative to the patient’s area of trouble. For example,
maintain all the parameters in the previous step, but increase the number of
tasks to be alternated between to 3.
Vs.
Continue with 2 tasks but make the tasks themselves more difficult.
Vs.
Continue with 2 tasks but decrease the amount of time allowed on
each task to 1 minute.
Vs.
Decrease the amount of time between tasks to 5 seconds.
Vs.
Continue the tasks for 4-5 cycles.

• Ultimately you will increase all these parameters such that the patient would
be required to do multiple, difficult tasks for 30 seconds each, with no break
in between for 15-20 minutes.

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Here are some ways to systematically increase variables in a cancellation task:

• “I’m going to give you a page filled with symbols. I would like you to cross off
the heart every time you see it for these first 5 lines. For the next 5 lines I
would like you to cross off the diamond. Continue to alternate back and forth
between hearts and diamonds every 5 lines.”
• “I’m going to give you a page filled with symbols. I would like you to cross off
the heart every time you see it for these first 3 lines. For the next 3 lines I
would like you to cross off the diamond. Continue to alternate back and forth
between hearts and diamonds every 3 lines.”
• “I’m going to give you a page filled with symbols. I would like you to cross off
the heart every time you see it on this first line. For the next line I would like
you to cross off the diamond. Continue to alternate back and forth between
hearts and diamonds every line.”
• “I’m going to give you a page filled with symbols. I would like you to begin by
crossing off all the hearts you see. In about 15 seconds I will say diamond and
for the next time period you should cross off the diamonds. Continue to alter-
nate back and forth between hearts and diamonds every time I instruct you
to switch.”

➤ Agitating Alternating
To work on alternating between various tasks, set up different “stations” that
the patient will alternate between. Here are some suggestions for the stations:
• Manipulate colored blocks. Provide the patient with 10 “blueprints”
stating the order or position where the blocks should be placed.
• Write the alphabet omitting the letters in your name.
• Read a newspaper article.
• Do a computer activity.
• Balance a checkbook.
• Solve simple puzzles.
• Alphabetize lists of words/papers.
• Set an alarm clock.
• Write the alphabet backwards.
• Count backwards from 100 by 4 (written or oral).
• Count forward by 5, then subtract 3 (written or oral).
• Do simple pegboard tasks.
• Perform simple reasoning activities.
• Complete an application.
• Write a letter of complaint.
• Write or copy a paragraph intentionally failing to dot all i’s and cross
all t’s.

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 Attention

Divided Attention
The ability to do more than one thing at a time is divided attention. Dividing
attention occurs often in daily life, such as when someone is driving, cooking, or work-
ing. The difficulty arises in determining how many tasks can attention successfully
be divided among.

There are several variables of difficulty that contribute to divided attention skills.
➤ Difficulty of each task: It is easier to divide attention between simple tasks.
➤ Familiarity of each task: It is easier to divide attention between known tasks.
➤ Enjoyment: It is easier to divide attention between enjoyable tasks.
➤ Number of tasks attention is divided between: The more tasks involved,
the more difficult.
➤ Length of time you must persist with these tasks: It is easier to divide
attention for shorter periods of time.

To assist patients in becoming aware of the number of tasks they function between,
ask them to complete the Simultaneous Tasks Worksheet on page 142 (a com-
pleted chart from the worksheet is on the next page). Having the patient complete
the chart during a treatment session will
be difficult, since it requires the person to
recall the number of functions he or she Helpful Hint: Both alternating attention and divided
attempted at one time. Therefore, this is attention fall under the heading of
an activity that a patient frequently needs “multi-tasking.” Today’s society val-
to complete as homework and review dur- ues the ability to “multi-task,” which is
ing the session. essentially the ability to alternate or
divide attention. The data is begin-
Divided attention tasks can easily be sim- ning to show, however, that multi-
plified by switching them to alternating tasking is not saving any time, in fact
attention tasks. For example, instead of it may be taking longer to complete
making the coffee and the toast at the tasks and they may be less accurate
same time, make the coffee and then make than if they are done one at a time.
the toast. Helping the patient to be sharply
aware of his or her abilities and limi-
tations with alternating and divided
attention will ultimately assist the
patient in being successful in complet-
ing tasks, whether they are done one
at a time or simultaneously.

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 Attention

Simultaneous Tasks Problems Modifications

Listening to weather

Taking a shower None None

Making coffee Lost track of number of coffee Prepare water and coffee grounds
scoops the evening before.

Making toast Burned the toast Don’t read the paper until seated
and breakfast is done.
Reading the paper

Listening to the news

Driving to work

Listening to voice mail Forgot message Listen to voice mail at home or at

work.

Working on the computer

Making phone calls Lost data while on phone Turn on voice mail while working.

Interruptions from Failed to complete project Put a sign on your door requesting
co-workers no interruptions.

Reading

Watching favorite TV Missed the main point of both the Tape show or defer reading until
show book and the TV show after the show is over.

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 Attention

In addition to managing reductions in divided attention via compensations, patients

can work on both clinical and functional tasks to increase their ability to divide atten-
tion between tasks. Highly structured, systematic increases of the amount and diffi-
culty of tasks can be successful. Have the patient perform a variety of activities
during the treatment session and homework for the pure activity of practice.
Systematically manipulate the following variables:
• the difficulty of each task
• the familiarity of each task
• the enjoyment of each task
• the number of tasks between which the patient is dividing attention

➤ Cancellation Tasks: The Cancellation Activities presented on pages 100-

115 provide excellent clinical tasks for alternating attention. These simple
tasks can be easily manipulated to address various attention issues.

Introducing the Task:

• “Here is a page of random letters. I Helpful Hint: An excellent and readily available
want you to cross out the letter t and tool for cancellation tasks is the daily
the letter z every time they appear. newspaper, which can be used for tar-
You’ll do this for about 1 minute.” geting different letters or numbers in
• “Here is a page of random letters. I different frequencies.
want you to cross out the letter t every
time it appears. I will be reading you a short news story. I want you to lis-
ten to the story while working on the letters, and I’ll ask you some questions
about it when we are done. You will do this for about 1 minute.”
• “Here is a page of random letters. I want you to cross out the letter t and the
letter a every time they appear. While you are doing this I want you to listen
to this weather forecast and be able to tell me the temperature tomorrow.
You’ll do this for about 3 minutes.”

Manipulating the Task:

• Have the patient scan for more than 1 target at a time.
• Manipulate the variables as described in the Sustained Attention section.
• Manipulate the variables as described in the Selective Attention section;
however, require the patient to pay attention to the distracting stimuli. For
example, have the patient continue crossing out letters while listening to a
news story and stating the main point.
• Manipulate the variables as described in the Alternating Attention section.
• Manipulate the number of target items scanned for.

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 Attention

➤ Math Equations: For those who enjoy math, a page of simple math equations
(pages 116-121 and 139-141) can be used for divided attention tasks. Require
the patient to complete math problems while attending to other tasks simulta-
neously. For example, have the patient solve the math problem while listening
to a news story or carrying on a conversation.

Manipulating the Task:

• Manipulate the variables as described in the Sustained Attention section.
• Manipulate the variables as described in the Selective Attention section;
however, require the patient to attend to the distracting stimuli. For example,
have the patient continue to cross out the designated target(s) while listening
to a news story and stating the main point of the story.
• Manipulate the variables as described in the Alternating Attention section.
• Manipulate the number of target items scanned for.

➤ Odd/Even Tasks: Ask the patient to sort a grid of numbers by odds/evens in

either ascending or descending order using the activities on pages 143-145.

Introducing the Task:

• “Here is a grid of numbers. I want you to sort the numbers by writing all the
even numbers on the right side of the page and the odd numbers on the left.
Put the smallest number at the top and then sort the numbers smallest to
largest.”

Manipulating the Task:

• Increase the amount of numbers on the grid.
• Increase the complexity of the numbers.

For any given task within the patient’s schedule, ask him or her to identify the stip-
ulations of attention:
• For how long is the patient required to sustain attention? Is that amount of
time within the patient’s ability? Is there a way to reduce the time prior to
the patient failing at the task?
• Will there be competing stimuli? Is there a way to decrease or eliminate that
competition before encountering it?
• Will the patient be asked to do more than one thing at a time? Is that with-
in the patient’s ability? Is there a way to reduce the alternating and divided
attention constraints prior to the activity?

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 Attention

➤ Mental Flexibility: Mental flexibility is the ability to see familiar situations

in a different fashion, handle different situations in different ways, and to
respond effectively to new situations. It involves the ability to do these things:
• see things from several different perspectives
• adapt to change
• learn from mistakes
• solve problems in new ways

When mental flexibility is impaired, patients perform well in familiar situations

when everything goes as planned, but in new situations, or old situations with
surprises, they exhibit difficulties. Faced with something unfamiliar, patients
either overlook its newness and treat it as a version of something familiar, or
they recognize its newness and treat it as difficult.

In order to alternate or divide attention, or participate successfully in the repair

phase (discussed in the next chapter, beginning on page 155), patients must pos-
sess the ability to be flexible in their thinking. The ability to mentally go down
one path, stop, go down another path, stop, and so forth, is a skill that is often
impaired with executive function disorders.

Analyze situations from the patient’s life experiences asking questions such as:
• Was there another way you could have done the activity?
• Was there another choice?
• How many solutions did you consider before trying this one?
• Did this go as originally planned? What alterations did you make if it didn’t?

Direct practice in mental flexibility can be helpful. The Homonyms Activities

on pages 146-149 are a linguistic task in mental flexibility. Present the words
on those pages to your patients and see how many different meanings he or she
can determine for the target word. Here are some examples:
• bowl a dish for eating cereal
to play a sport with a ball and pins
an important college football game

• spring a season of the year

a coil
to jump up suddenly
a small stream or brook

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 Attention

The Trail Activities on pages

150-153 provide another task Divided Attention Activities Trail Activity 1

to promote mental flexibility.

Give the patient a copy of one of
A
the pages containing letters of I
the alphabet and numbers. E
Ask the patient to connect the
letters and numbers in order 6 5 J
B
but in an alternating fashion,
for example, A-1-B-2-C-3 etc.,
as in the example pictured F
here. 1
7
Mental flexibility can also be 8
practiced by playing a rule- D
shifting card game. Sort a deck
of playing cards, and have the 3 10
patient work to determine why
a card is included in the “Yes” 4 G
pile as opposed to the “No” pile
based upon predetermined cri- C 9
teria known only to the thera-
pist. For example, if the prede- H 2
termined rule is “only red
cards”:
• The patient turns over the 3 of hearts and the therapist says “Yes.”
• The patient turns over the 4 of spades, the therapist says “No.”

Once the patient has ascertained the rule, the therapist switches to another
rule, without notification. For example, this time the predetermined rule is
“only even numbers”:
• The patient turns over the 3 of diamonds and the therapist says “No.”
• The patient turns over the 8 of clubs and the therapist says “Yes.”

See the Rule Shift List on page 154 for suggestions of predetermined rules.

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 Required Attention Levels

Name: Date:

Task Required Attention Levels

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

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 Activity Worksheet

Name: Date:

Concentration Break Time

Activity Time & Activity Was It Successful? Why? Modifications

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 Cancellation Activities Letters 1

f p o i a u t o i b n o k j
p o t u o i t j a o v j p i
u j v o i j i u o y j l k m
l k s d j o i t u r e o s i
j s k v k n b u i y e u k j
h z i y t z y f i u s g m f
n l k p o t k l m l y p o y
k m l k m k f d j g i h s g
k j b v j s a f u y a b v d
k g h i u t r k j o i j n o
p j o i b i h u i c g y u q
y y u g h i o v w j m o i n
j o r i o y k p o p e i o w
u i w e h r u q t r a b k j
n b m n l g k u p o m n m o
i t s u g i n m n v k u a y
i u y f i u h f n k v n n v
m z b v h u z g f u z g f y
t q g y u e h t i h s y j d
o j m l k n m l m n p b j n
d i o j g h o i u h f a u y

The Source for Executive Function Disorders 100 Copyright © 2003 LinguiSystems, Inc.
 Cancellation Activities Letters 2

i j n o o i b i h u i c g
y u q y y u g h i o v w j
o r i o y k p o p e i o w
u i w e h r u q w t r a b
k j n b m n l g k u p g n
m n v k u a y i u y f i u
h f n k v n n v m z b v h
u z g f u z g f y t q g y
u e h t i h s y j d o j m
l k n m l m n p b j n d i
q j g h o i u h f a u y w
f i b v k j g n v l k s m
h j h p o i e r j h k m b
o i s p j g o i h g a i u
h u i w n c q n v y u i a
f u y a b v d k g h i u t
r k j o i j n o p j o i b
i h u i c g y u q y y u g
h i o v w j m o i n j o r
i o y k p o p e i o w e h
r u q w t r a b k j n b m
n l g k u p o m n m o i t
s u g i n m n v k u a y i
u y f i u h f n k v n n v
m z b v h u z g f u z g f
y t q g y u e h t i h s y
j d o j m l k n u i w n c
q n v y u i a f u f p o i
a u t o i b n o k j p o t
u o i t j a o v j p i u j
v o i j i u o g j l k m l
k s d j o i t u r e o s i
j s k v k n b u i y e u k
j h z i y t z y f i u s g
m f n l k p o t k l m l y
p o y k m l k m k f d j g
i h s g k j b v j s a f u
y a b v d k g h i u t r k
j o i j n o p j o i b i h
u i c g y u q y y u g h i
o v w j m o i n j o r i o

The Source for Executive Function Disorders 101 Copyright © 2003 LinguiSystems, Inc.
 Cancellation Activities Letters 3

i j n o o i b i h u i c g z y u q y y u g h i o v
w j o r i o y k p o p e i o w u i w e h r u q w t
a b q k j n b m n l g k u p g n o m n v k u a y i
y f i u y h f n k v n n v m z b v h v u z g f u z
f y t q g y u u e h t i h s y j d o j m t l k n m
m n p b j n d i a q j g h o i u h f a u y w a f i
v k j g n v l k s m o h j h p o i e r j h k m b y
i s p j g o i h g a i u g h u i w n c q n v y u i
v f u y a b v d k g h i u t n r k j o i j n o p j
i b w i h u i c g y u q y y u g s h i o v w j m o
n j o r q i o y k p o p e i o w e h t r u q w t r
b k j n b m r n l g k u p o m n m o i t v s u g i
m n v k u a y i x u y f i u h f n k v n n v w m z
v h u z g f u z g f y y t q g y u e h t i h s y a
d o j m l k n u i w n c b q n v y u i a f u f p o
c a u t o i b n o k j p o t e u o i t j a o v j p
u j d v o i j i u o g j l k m l f k s d j o i t u
e o s i h j s k v k n b u i y e u k g j h z i y t
y f i u s g i m f n l k p o t k l m l y j p o y k
l k m k f d j g k i h s g k j b v j s a f u l y a
v d k g h i u t r k m j o i j n o p j o i b i h n
i c g y u q y y u g h i p o v w j m o i n j o r i
y k p o p e if p o i a u t o i b n o k j p o t u o
t j a o v j p i u j v o i j i j l k m l k s d j o
i t u r e o s i j s k v k n a u i y e u k j h z i
y t z y f i u s g m f n l k p c t k l m l y p o y
k m l k m k f d j g i h s g k j u v j s a f u y a
b v d k g h i u t r k j o i j n o w j o i b i h u
i c g y u q y y u g h i o v w j m o x n j o r i o
y k p o p e i o w u i w e h r u q t r z b k j n b
m n l g k u p o m n m o i t s u g i n m a v k u a
y i u y f i u h f n k v n n v m z b v h u b g f u
z g f y t q g y u e h t i h s y j d o j m l d n m
l m n p b j n d i o j g h o i u h f a u y w f e b
v k j g n v l k s m h j h p o i e r j h k m b o f
s p j g o i h g a i u h u i w n c q n v y u i a f
y a q v d k g h i u t r k j o i j n o p j o i b i
u i c g y u q y y u g h i o v w j m o i n j o r i
y k p o p o w u i w e h r u q w t r a b k j n b m
l g k u p o m t r k m j o i j n o p j o i b i h n
i c g y u q y y u g h i p o v w j m o i n j o r i
y k p o p e if p o i a u t o i b n o k j p o t u o
t j a o v j p i u j v o i j i j l k m l k s d j o
i t u r e o s i j s k v k n a u i y e u k j h z i
b v d k g h i u t r k j o i j n o w j o i b i h u

The Source for Executive Function Disorders 102 Copyright © 2003 LinguiSystems, Inc.
 Cancellation Activities Letters 4

F P O I A U T O I B N O K J
P O T U O I T J A O V J P I
U J V O I J I U O Y J L K M
L K S D J O I T U R E O S I
J S K V K N B U I Y E U K J
H Z I Y T Z Y F I U S G M F
N L K P O T K L M L Y P O Y
K M L K M K F D J G I H S G
K J B V J S A F U Y A B V D
K G H I U T R K J O I J N O
P J O I B I H U I C G Y U Q
Y Y U G H I O V W J M O I N
J O R I O Y K P O P E I O W
U I W E H R U Q T R A B K J
N B M N L G K U P O M N M O
I T S U G I N M N V K U A Y
I U Y F I U H F N K V N N V
M Z B V H U Z G F U Z G F Y
T Q G Y U E H T I H S Y J D
O J M L K N M L M N P B J N
D I O J G H O I U H F A U Y

The Source for Executive Function Disorders 103 Copyright © 2003 LinguiSystems, Inc.
 Cancellation Activities Letters 5

I J N O O I B I H U I C G
Y U Q Y Y U G H I O V W J
O R I O Y K P O P E I O W
U I W E H R U Q W T R A B
K J N B M N L G K U P G N
M N V K U A Y I U Y F I U
H F N K V N N V M Z B V H
U Z G F U Z G F Y T Q G Y
U E H T I H S Y J D O J M
L K N M L M N P B J N D I
Q J G H O I U H F A U Y W
F I B V K J G N V L K S M
H J H P O I E R J H K M B
O I S P J G O I H G A I U
H U I W N C Q N V Y U I A
F U Y A B V D K G H I U T
R K J O I J N O P J O I B
I H U I C G Y U Q Y Y U G
H I O V W J M O I N J O R
I O Y K P O P E I O W E H
R U Q W T R A B K J N B M
N L G K U P O M N M O I T
S U G I N M N V K U A Y I
U Y F I U H F N K V N N V
M Z B V H U Z G F U Z G F
Y T Q G Y U E H T I H S Y
J D O J M L K N U I W N C
Q N V Y U I A F U F P O I
A U T O I B N O K J P O T
U O I T J A O V J P I U J
V O I J I U O G J L K M L
K S D J O I T U R E O S I
J S K V K N B U I Y E U K
J H Z I Y T Z Y F I U S G
M F N L K P O T K L M L Y
P O Y K M L K M K F D J G
I H S G K J B V J S A F U
Y A B V D K G H I U T R K
J O I J N O P J O I B I H
U I C G Y U Q Y Y U G H I
O V W J M O I N J O R I O

The Source for Executive Function Disorders 104 Copyright © 2003 LinguiSystems, Inc.
 Cancellation Activities Letters 6

U J D V O I J I U O G J L K M L F K S D J O I T U
E O S I H J S K V K N B U I Y E U K G J H Z I Y T
Y F I U S G I M F N L K P O T K L M L Y J P O Y K
L K M K F D J G K I H S G K J B V J S A F U L Y A
V D K G H I U T R K M J O I J N O P J O I B I H N
I C G Y U Q Y Y U G H I P O V W J M O I N J O R I
Y K P O P E IF P O I A U T O I B N O K J P O T U O
T J A O V J P I U J V O I J I J L K M L K S D J O
I T U R E O S I J S K V K N A U I Y E U K J H Z I
Y T Z Y F I U S G M F N L K P C T K L M L Y P O Y
K M L K M K F D J G I H S G K J U V J S A F U Y A
B V D K G H I U T R K J O I J N O W J O I B I H U
I C G Y U Q Y Y U G H I O V W J M O X N J O R I O
I J N O O I B I H U I C G Z Y U Q Y Y U G H I O V
W J O R I O Y K P O P E I O W U I W E H R U Q W T
A B Q K J N B M N L G K U P G N O M N V K U A Y I
Y F I U Y H F N K V N N V M Z B V H V U Z G F U Z
F Y T Q G Y U U E H T I H S Y J D O J M T L K N M
M N P B J N D I A Q J G H O I U H F A U Y W A F I
V K J G N V L K S M O H J H P O I E R J H K M B Y
I S P J G O I H G A I U G H U I W N C Q N V Y U I
V F U Y A B V D K G H I U T N R K J O I J N O P J
I B W I H U I C G Y U Q Y Y U G S H I O V W J M O
N J O R Q I O Y K P O P E I O W E H T R U Q W T R
B K J N B M R N L G K U P O M N M O I T V S U G I
M N V K U A Y I X U Y F I U H F N K V N N V W M Z
V H U Z G F U Z G F Y Y T Q G Y U E H T I H S Y A
D O J M L K N U I W N C B Q N V Y U I A F U F P O
C A U T O I B N O K J P O T E U O I T J A O V J P
Y K P O P E I O W U I W E H R U Q T R Z B K J N B
M N L G K U P O M N M O I T S U G I N M A V K U A
Y I U Y F I U H F N K V N N V M Z B V H U B G F U
Z G F Y T Q G Y U E H T I H S Y J D O J M L D N M
L M N P B J N D I O J G H O I U H F A U Y W F E B
V K J G N V L K S M H J H P O I E R J H K M B O F
S P J G O I H G A I U H U I W N C Q N V Y U I A F
Y A Q V D K G H I U T R K J O I J N O P J O I B I
U I C G Y U Q Y Y U G H I O V W J M O I N J O R I
Y K P O P O W U I W E H R U Q W T R A B K J N B M
L G K U P O M T R K M J O I J N O P J O I B I H N
I C G Y U Q Y Y U G H I P O V W J M O I N J O R I
Y K P O P E IF P O I A U T O I B N O K J P O T U O
T J A O V J P I U J V O I J I J L K M L K S D J O
I T U R E O S I J S K V K N A U I Y E U K J H Z I
B V D K G H I U T R K J O I J N O W J O I B I H U

The Source for Executive Function Disorders 105 Copyright © 2003 LinguiSystems, Inc.
 Cancellation Activities Symbols 1

The Source for Executive Function Disorders 106 Copyright © 2003 LinguiSystems, Inc.
 Cancellation Activities Symbols 2

The Source for Executive Function Disorders 107 Copyright © 2003 LinguiSystems, Inc.
 Cancellation Activities Symbols 3

☺ ☺ ☺ ☺ ☺ ☺
☺ ☺ ☺ ☺ ☺ ☺
☺ ☺ ☺
☺ ☺ ☺
☺ ☺ ☺
☺ ☺ ☺
☺ ☺
☺ ☺ ☺ ☺
☺ ☺ ☺ ☺
☺ ☺
☺ ☺ ☺ ☺
☺
☺ ☺ ☺
☺ ☺ ☺
☺ ☺ ☺ ☺ ☺
☺ ☺ ☺ ☺ ☺
☺ ☺ ☺
☺ ☺ ☺ ☺ ☺ ☺ ☺ ☺
☺ ☺ ☺ ☺ ☺
☺ ☺ ☺ ☺
☺ ☺ ☺ ☺ ☺
☺ ☺
☺ ☺ ☺ ☺

The Source for Executive Function Disorders 108 Copyright © 2003 LinguiSystems, Inc.
 Cancellation Activities Symbols 4

☺ ☺ ☺ ☺ ☺ ☺
☺ ☺ ☺ ☺ ☺ ☺
☺ ☺ ☺
☺ ☺ ☺
☺ ☺ ☺
☺ ☺ ☺
☺ ☺
☺ ☺ ☺ ☺
☺ ☺ ☺ ☺
☺ ☺
☺ ☺ ☺ ☺
☺
☺ ☺ ☺
☺ ☺ ☺
☺ ☺ ☺ ☺ ☺
☺ ☺ ☺ ☺ ☺
☺ ☺ ☺
☺ ☺ ☺ ☺ ☺ ☺ ☺ ☺
☺ ☺ ☺ ☺ ☺
☺ ☺ ☺ ☺
☺ ☺ ☺ ☺ ☺
☺ ☺
☺ ☺ ☺ ☺
☺ ☺ ☺
☺ ☺
☺ ☺ ☺ ☺
☺ ☺ ☺ ☺
☺ ☺
☺ ☺ ☺ ☺
☺
☺ ☺ ☺
☺ ☺ ☺
☺ ☺ ☺ ☺ ☺
☺ ☺ ☺ ☺ ☺
☺ ☺ ☺
☺ ☺ ☺
☺ ☺ ☺
☺ ☺
☺ ☺ ☺ ☺
☺ ☺ ☺ ☺
☺ ☺

The Source for Executive Function Disorders 109 Copyright © 2003 LinguiSystems, Inc.
 Cancellation Activities Symbols 5

÷ + − ÷ ÷ + ÷ ÷ − + + ÷ +
÷ + ÷ ÷ − − + ÷ ÷ + + + ÷
− + ÷ + + ÷ − + − − ÷ + +
+ ÷ − + + + − ÷ − − − − ÷
− + − ÷ + ÷ + − + − + + ÷
+ − ÷ + + − − + ÷ + − ÷ +
+ ÷ − + − − + ÷ + + + − +
− ÷ + − + + − ÷ + ÷ ÷ + −
+ + + + − ÷ + ÷ − ÷ + − ÷
− ÷ + + + − − − − ÷ − + +
+ − + + − ÷ − + ÷ ÷ − + ÷
− − ÷ + + + − − − + + − −
− ÷ + − + ÷ ÷ + + + − − +
+ − ÷ ÷ − + + − + − + + ÷
÷ + + ÷ ÷ − ÷ + + − − + ÷
+ ÷ − ÷ ÷ ÷ ÷ + + − + + −
− − − − ÷ ÷ ÷ + + + − − +
÷ ÷ − ÷ + + ÷ ÷ ÷ − ÷ ÷ +
− ÷ ÷ − ÷ − + + + + ÷ − ÷
− ÷ − ÷ ÷ − − + − + + ÷ −
÷ ÷ − + ÷ − + − ÷ + ÷ − −
− + − + ÷ + + + + + ÷ + +
÷ ÷ + − − − ÷ + − + + + ÷
The Source for Executive Function Disorders 110 Copyright © 2003 LinguiSystems, Inc.
 Cancellation Activities Symbols 6

+ ÷ − + + ÷ + + − ÷ ÷ + ÷
+ ÷ + + − − ÷ + + ÷ ÷ ÷ +
− ÷ + ÷ ÷ + − ÷ − − + ÷ ÷
÷ + − ÷ ÷ ÷ − + − − − − +
− ÷ − + ÷ + ÷ − ÷ − ÷ ÷ +
÷ − + ÷ ÷ − − ÷ + ÷ − + ÷
÷ + − ÷ − − ÷ + ÷ ÷ ÷ − ÷
− + ÷ − ÷ ÷ − + ÷ + + ÷ −
÷ ÷ ÷ ÷ − + ÷ + − + ÷ − +
− + ÷ ÷ ÷ − − − − + − ÷ ÷
÷ − ÷ ÷ − + − ÷ + + − ÷ +
− − + ÷ ÷ ÷ − − − ÷ ÷ − −
− + ÷ − ÷ + + ÷ ÷ ÷ − − ÷
÷ − + + − ÷ ÷ − ÷ − ÷ ÷ +
+ ÷ ÷ + + − + ÷ ÷ − − ÷ +
÷ + − + + + + ÷ ÷ − ÷ ÷ −
− − − − + + + ÷ ÷ ÷ − − ÷
+ + − + ÷ ÷ + + + − + + ÷
− + + − + − ÷ ÷ ÷ ÷ + − +
− + − + + − − ÷ − ÷ ÷ + −
+ + − ÷ + − ÷ − + ÷ + − −
− ÷ − ÷ + ÷ ÷ ÷ ÷ ÷ + ÷ ÷
+ + ÷ − − − + ÷ − ÷ ÷ ÷ +
÷ ÷ + ÷ ÷ − − ÷ + ÷ − + ÷
÷ + − ÷ − − ÷ + ÷ ÷ ÷ − ÷
− + ÷ − ÷ ÷ − + ÷ + + ÷ −
÷ ÷ ÷ ÷ − + ÷ + − + ÷ − +
− + ÷ ÷ ÷ − − − − + − ÷ ÷
÷ − ÷ ÷ − + − ÷ + + − ÷ +
− − + ÷ ÷ ÷ − − − ÷ ÷ − −
− + ÷ − ÷ + + ÷ ÷ ÷ − − ÷
÷ − + + − ÷ ÷ − ÷ − ÷ ÷ +
+ ÷ ÷ + + − + ÷ ÷ − − ÷ +
÷ + − + + + + ÷ ÷ − ÷ ÷ −
− − − − + + + ÷ ÷ ÷ − − ÷
− ÷ − + ÷ + ÷ − ÷ − ÷ ÷ +
÷ − + ÷ ÷ − − ÷ + ÷ − + ÷
÷ + − ÷ − − ÷ + ÷ ÷ ÷ − ÷
− + ÷ − ÷ ÷ − + ÷ + + ÷ −
÷ ÷ ÷ ÷ − + ÷ + − + ÷ − +
− + ÷ ÷ ÷ − − − − + − ÷ ÷

The Source for Executive Function Disorders 111 Copyright © 2003 LinguiSystems, Inc.
 Cancellation Activities Symbols 7

■ ● ▲ ◆ ◆ ■ ◆ ■ ■ ● ● ◆ ●
◆ ■ ◆ ■ ▲ ▲ ● ◆ ◆ ● ● ■ ◆
▲ ● ■ ● ● ◆ ▲ ■ ■ ▲ ◆ ● ●
● ◆ ▲ ■ ● ● ▲ ■ ▲ ■ ▲ ▲ ◆
▲ ● ▲ ◆ ● ◆ ■ ■ ● ▲ ● ● ■
● ▲ ◆ ■ ● ▲ ▲ ● ◆ ● ■ ◆ ●
■ ■ ▲ ● ▲ ▲ ● ◆ ● ● ■ ■ ●
▲ ◆ ● ▲ ● ● ▲ ◆ ■ ■ ◆ ● ■
● ● ● ■ ▲ ◆ ● ◆ ▲ ■ ● ▲ ◆
▲ ◆ ● ● ■ ■ ▲ ▲ ▲ ◆ ▲ ● ●
● ■ ● ■ ▲ ■ ▲ ● ◆ ◆ ▲ ● ◆
▲ ■ ■ ● ● ■ ▲ ▲ ▲ ● ● ▲ ■
▲ ◆ ● ▲ ● ◆ ◆ ■ ● ● ▲ ▲ ●
● ■ ■ ◆ ▲ ■ ● ▲ ● ▲ ● ● ◆
◆ ■ ● ■ ◆ ▲ ◆ ● ● ■ ▲ ● ◆
■ ■ ▲ ◆ ◆ ◆ ■ ● ● ▲ ● ● ▲
■ ▲ ▲ ▲ ◆ ◆ ◆ ■ ● ● ▲ ■ ●
■ ◆ ▲ ◆ ● ■ ◆ ■ ◆ ▲ ◆ ◆ ●
▲ ■ ◆ ▲ ◆ ■ ● ● ● ■ ◆ ▲ ■
▲ ◆ ▲ ◆ ◆ ▲ ▲ ● ■ ● ● ■ ▲
◆ ◆ ▲ ● ◆ ▲ ■ ▲ ■ ● ◆ ■ ▲
▲ ● ▲ ● ◆ ■ ● ● ● ■ ◆ ● ●
■ ◆ ● ▲ ■ ▲ ◆ ■ ▲ ● ● ● ◆

The Source for Executive Function Disorders 112 Copyright © 2003 LinguiSystems, Inc.
 Cancellation Activities Symbols 8

● ◆ ▲ ■ ● ● ▲ ■ ▲ ■ ▲ ▲ ◆
▲ ● ▲ ◆ ● ◆ ■ ■ ● ▲ ● ● ■
● ▲ ◆ ■ ● ▲ ▲ ● ◆ ● ■ ◆ ●
■ ■ ▲ ● ▲ ▲ ● ◆ ● ● ■ ■ ●
▲ ◆ ● ▲ ● ● ▲ ◆ ■ ■ ◆ ● ■
● ● ● ■ ▲ ◆ ● ◆ ▲ ■ ● ▲ ◆
▲ ◆ ● ● ■ ■ ▲ ▲ ▲ ◆ ▲ ● ●
● ■ ● ■ ▲ ■ ▲ ● ◆ ◆ ▲ ● ◆
▲ ■ ■ ● ● ■ ▲ ▲ ▲ ● ● ▲ ■
▲ ◆ ● ▲ ● ◆ ◆ ■ ● ● ▲ ▲ ●
● ■ ■ ◆ ▲ ■ ● ▲ ● ▲ ● ● ◆
◆ ■ ● ■ ◆ ▲ ◆ ● ● ■ ▲ ● ◆
■ ■ ▲ ◆ ◆ ◆ ■ ● ● ▲ ● ● ▲
■ ▲ ▲ ▲ ◆ ◆ ◆ ■ ● ● ▲ ■ ●
■ ◆ ▲ ◆ ● ■ ◆ ■ ◆ ▲ ◆ ◆ ●
▲ ■ ◆ ▲ ◆ ■ ● ● ● ■ ◆ ▲ ■
▲ ◆ ▲ ◆ ◆ ▲ ▲ ● ■ ● ● ■ ▲
◆ ◆ ▲ ● ◆ ▲ ■ ▲ ■ ● ◆ ■ ▲
▲ ● ▲ ● ◆ ■ ● ● ● ■ ◆ ● ●
■ ◆ ● ▲ ■ ▲ ◆ ■ ▲ ● ● ● ◆
◆ ▲ ● ● ■ ■ ▲ ▲ ▲ ◆ ▲ ● ●
● ■ ● ■ ▲ ■ ▲ ● ◆ ◆ ▲ ● ◆
▲ ■ ■ ● ● ■ ▲ ▲ ▲ ● ● ▲ ■
▲ ◆ ● ▲ ● ◆ ◆ ■ ● ● ▲ ▲ ●
● ■ ■ ◆ ▲ ■ ● ▲ ● ▲ ● ● ◆
◆ ■ ● ■ ◆ ▲ ◆ ● ● ■ ▲ ● ◆
■ ● ● ● ■ ■ ▲ ▲ ▲ ◆ ▲ ● ●
● ■ ● ■ ▲ ■ ▲ ● ◆ ◆ ▲ ● ◆
▲ ■ ■ ● ● ■ ▲ ▲ ▲ ● ● ▲ ■
▲ ◆ ● ▲ ● ◆ ◆ ■ ● ● ▲ ▲ ●
● ■ ■ ◆ ▲ ■ ● ▲ ● ▲ ● ● ◆
◆ ■ ● ■ ◆ ▲ ◆ ● ● ■ ▲ ● ◆
▲ ◆ ● ▲ ● ● ▲ ◆ ■ ■ ◆ ● ■

The Source for Executive Function Disorders 113 Copyright © 2003 LinguiSystems, Inc.
 Cancellation Activities Numbers 1

1 5 6 3 9 8 1 3 4 5 7 5 6
2 6 7 8 5 9 4 2 1 3 5 9 8
4 5 3 2 3 6 5 8 4 6 5 4 2
9 6 4 5 3 2 1 8 5 7 5 4 2
1 2 5 6 7 5 8 2 8 4 5 5 3
3 3 5 6 8 5 4 7 8 9 6 3 4
6 3 7 7 5 9 1 2 6 4 8 3 2
8 6 2 6 4 5 3 5 8 4 6 5 2
3 4 5 3 2 8 6 9 2 5 7 4 6
1 6 5 8 4 3 2 1 4 7 5 8 6
3 2 6 6 8 8 4 6 5 3 8 4 5
6 2 7 3 6 5 2 8 9 1 4 8 7
4 5 6 3 2 8 6 4 8 5 9 2 1
1 6 8 5 8 9 5 4 2 3 1 4 6
7 4 6 8 2 8 3 4 8 5 1 7 5
1 2 6 7 5 8 6 4 9 2 4 8 5
1 4 6 5 8 9 7 5 2 5 8 4 7
9 1 4 6 8 7 5 9 5 3 1 2 6
4 5 8 7 6 2 6 4 2 1 9 5 4
8 8 4 6 5 9 5 4 3 2 1 5 8
3 9 4 5 8 7 2 6 1 2 3 7 5
1 6 5 8 5 7 4 5 9 6 5 3 2
2 5 2 2 5 4 6 8 5 9 7 3 6

The Source for Executive Function Disorders 114 Copyright © 2003 LinguiSystems, Inc.
 Cancellation Activities Numbers 2

8 4 3 2 1 4 7 5 8 6 5 3 4
3 2 6 6 8 8 4 6 5 3 8 4 5
6 2 7 3 6 5 2 8 9 1 4 8 7
4 5 6 3 2 8 6 4 8 5 9 2 1
1 6 8 5 8 9 5 4 2 3 1 4 6
7 4 6 8 2 8 3 4 8 5 1 7 5
1 5 6 3 9 8 1 3 4 5 7 5 6
2 6 7 8 5 9 4 2 1 3 5 9 8
4 5 3 2 3 6 5 8 4 6 5 4 2
9 6 4 5 3 2 1 8 5 7 5 4 2
1 2 5 6 7 5 8 2 8 4 5 5 3
3 3 5 6 8 5 4 7 8 9 6 3 4
6 3 7 7 5 9 1 2 6 4 8 3 2
8 6 2 6 4 5 3 5 8 4 6 5 2
3 4 5 3 2 8 6 9 2 5 7 4 6
1 6 5 8 4 3 2 1 4 7 5 8 6
3 2 6 6 8 8 4 6 5 3 8 4 5
6 2 7 3 6 5 2 8 9 1 4 8 7
4 5 6 3 2 8 6 4 8 5 9 2 1
1 6 8 5 8 9 5 4 2 3 1 4 6
7 4 6 8 2 8 3 4 8 5 1 7 5
1 2 6 7 5 8 6 4 9 2 4 8 5
1 4 6 5 8 9 7 5 2 5 8 4 7
9 1 4 6 8 7 5 9 5 3 1 2 6
4 5 8 7 6 2 6 4 2 1 9 5 4
8 8 4 6 5 9 5 4 3 2 1 5 8
3 9 4 5 8 7 2 6 1 2 3 7 5
1 6 5 8 5 7 4 5 9 6 5 3 2
2 5 2 2 5 4 6 8 5 9 7 3 6
3 6 8 6 8 5 4 7 8 9 6 3 4
6 3 7 7 5 9 1 2 6 4 8 3 2
8 6 2 6 4 5 3 5 8 4 6 5 2
3 4 5 3 2 8 6 9 2 5 7 4 6
9 5 8 4 6 3 2 8 4 5 1 5 6
1 2 5 8 6 2 6 7 5 8 4 8 8
7 6 3 4 8 9 5 1 2 8 6 2 1

The Source for Executive Function Disorders 115 Copyright © 2003 LinguiSystems, Inc.
 Math Equations 1-Digit Addition

1 2 6 4 4 3 4 1 6 7 9 8 4
+9 +7 +5 +2 +6 +2 +6 +7 +5 +7 +2 +9 +7

5 7 5 9 1 8 5 2 8 5 6 2 7
+6 +9 +8 +2 +7 +6 +9 +4 +6 +8 +0 +9 +6

2 0 2 7 9 8 7 1 6 8 8 7 1
+9 +8 +5 +0 +9 +6 +0 +9 +2 +8 +6 +7 +5

9 8 3 1 5 9 8 1 7 9 0 1 7
+4 +9 +8 +1 +2 +7 +9 +8 +9 +5 +8 +0 +9

3 2 8 6 0 9 8 6 8 9 2 7 5
+9 +8 +1 +7 +2 +4 +7 +1 +9 +8 +4 +0 +1

9 2 5 0 9 3 8 6 0 9 2 8 2
+5 +9 +8 +7 +2 +9 +8 +5 +9 +8 +2 +5 +7

9 8 2 5 6 0 9 3 6 0 4 9 0
+5 +9 +0 +5 +4 +0 +7 +5 +0 +9 +6 +8 +3

9 0 8 9 8 1 7 9 8 1 4 9 1
+7 +4 +9 +8 +1 +0 +5 +9 +2 +0 +6 +9 +4

3 6 9 5 9 7 0 5 9 7 0 5 0
+9 +3 +5 +0 +2 +9 +9 +2 +0 +3 +8 +3 +9

0 8 5 9 0 8 2 7 9 8 2 7 8
+9 +1 +2 +4 +8 +1 +7 +4 +9 +0 +8 +7 +2

9 8 7 9 8 6 8 4 0 9 3 8 6
+0 +3 +8 +7 +0 +9 +6 +0 +3 +4 +9 +5 +9

The Source for Executive Function Disorders 116 Copyright © 2003 LinguiSystems, Inc.
 Math Equations 1-Digit Subtraction

9 7 6 4 6 3 6 7 6 7 9 9 7
–1 –2 –5 –2 –4 –2 –4 –1 –5 –7 –2 –8 –4

6 9 8 9 7 8 9 4 8 8 6 9 7
–5 –7 –5 –2 –1 –6 –5 –2 –6 –5 –0 –2 –6

9 8 5 7 9 8 7 9 6 8 8 7 5
–2 –0 –2 –0 –9 –6 –0 –1 –2 –8 –6 –7 –1

9 9 8 1 5 9 9 8 9 9 8 1 9
–4 –8 –3 –1 –2 –7 –8 –1 –7 –5 –0 –0 –7

9 8 8 7 2 9 8 6 9 9 4 7 5
–2 –2 –1 –6 –0 –4 –7 –1 –5 –8 –2 –0 –1

9 9 8 7 9 9 8 6 9 8 2 8 7
–5 –2 –5 –0 –2 –3 –8 –5 –0 –6 –2 –5 –2

9 9 2 5 6 0 9 5 6 9 6 9 3
–5 –8 –0 –5 –4 –0 –7 –3 –0 –0 –4 –8 –0

9 4 9 9 8 1 7 9 8 1 6 9 4
–7 –0 –0 –3 –1 –0 –5 –2 –2 –0 –3 –9 –3

7 6 9 5 9 9 9 5 4 7 8 5 6
–3 –3 –5 –0 –2 –7 –0 –2 –0 –3 –0 –3 –0

9 8 5 9 8 8 7 7 9 8 8 7 2
–4 –1 –2 –5 –5 –1 –4 –3 –9 –0 –2 –7 –2

5 8 8 9 8 9 8 4 3 9 9 8 9
–5 –3 –1 –7 –0 –6 –6 –0 –0 –4 –8 –5 –6

The Source for Executive Function Disorders 117 Copyright © 2003 LinguiSystems, Inc.
 Math Equations 2-Digit Addition

52 75 73 65 46 53 51 33 54 98 27 64 65
+45 +17 +65 +68 +47 +89 +77 +68 +50 +18 +56 +97 +88

54 77 51 56 56 27 58 92 34 12 23 85 92
+89 +21 +82 +74 +98 +27 +98 +56 +98 +34 +75 +99 +18

50 92 39 85 79 85 70 91 32 98 75 98 75
+89 +27 +59 +89 +86 +72 +98 +57 +98 +10 +47 +81 +65

25 93 27 89 57 29 84 19 82 47 89 75 72
+93 +85 +72 +98 +57 +35 +79 +83 +75 +89 +83 +27 +48

21 76 26 58 28 50 43 68 93 99 86 76 57
+64 +63 +62 +76 +38 +79 +85 +36 +79 +30 +98 +90 +78

79 44 58 79 45 78 34 74 23 63 28 79 83
+24 +98 +72 +29 +84 +39 +87 +32 +48 +52 +37 +63 +46

42 13 64 23 32 46 34 87 98 59 56 35 60
+97 +93 +86 +97 +69 +89 +86 +78 +96 +38 +76 +72 +51

54 87 85 98 90 97 19 87 93 79 82 78 71
+87 +68 +79 +68 +26 +46 +47 +69 +85 +29 +45 +81 +36

46 75 65 73 28 56 59 51 49 75 68 55 49
+42 +65 +72 +74 +65 +41 +56 +25 +98 +56 +32 +85 +68

97 58 97 59 87 62 65 88 96 57 64 23 22
+95 +21 +89 +25 +23 +28 +56 +24 +75 +64 +28 +94 +25

92 35 30 42 31 43 26 89 90 57 99 75 77
+80 +97 +50 +97 +52 +65 +90 +65 +28 +59 +81 +27 +50

The Source for Executive Function Disorders 118 Copyright © 2003 LinguiSystems, Inc.
 Math Equations 2-Digit Subtraction

99 57 86 97 69 89 86 87 98 59 76 72 60
–97 –43 –64 –23 –32 –46 –34 –78 –66 –38 –56 –35 –51

87 87 85 98 90 97 47 87 93 79 82 81 71
–54 –68 –79 –68 –26 –46 –19 –69 –85 –29 –45 –78 –36

46 75 72 74 65 56 59 51 98 75 68 85 68
–42 –65 –65 –24 –28 –41 –36 –25 –49 –56 –32 –55 –49

97 58 97 59 87 62 65 88 96 57 64 94 25
–95 –21 –89 –25 –23 –28 –56 –24 –75 –64 –28 –23 –22

92 97 50 97 52 65 90 89 90 59 99 75 77
–80 –35 –30 –42 –31 –43 –26 –65 –28 –57 –81 –27 –50

52 75 73 68 47 89 77 68 54 98 56 97 88
–45 –17 –65 –15 –34 –53 –51 –33 –50 –18 –27 –64 –65

89 77 82 74 98 27 98 92 48 34 75 99 92
–54 –21 –51 –56 –56 –27 –58 –56 –14 –12 –23 –85 –18

89 92 59 89 86 85 98 91 98 98 75 98 75
–50 –27 –39 –59 –79 –72 –70 –57 –32 –10 –47 –81 –65

93 93 72 98 57 35 84 83 82 89 89 75 72
–25 –85 –27 –89 –57 –29 –79 –19 –75 –47 –83 –27 –48

64 76 62 76 38 79 82 68 93 99 98 90 78
–21 –63 –26 –58 –28 –50 –43 –36 –79 –30 –86 –76 –57

79 98 72 79 84 78 87 74 48 63 37 79 83
–24 –44 –58 –29 –49 –39 –34 –32 –23 –52 –28 –63 –46

The Source for Executive Function Disorders 119 Copyright © 2003 LinguiSystems, Inc.
 Math Equations 3-Digit Addition

571 980 579 819 824 761 875 698 570

+801 +658 +701 +209 +812 +740 +917 +515 +687

164 875 834 984 985 872 348 723 175

+890 +986 +596 +298 +549 +889 +723 +872 +186

585 109 920 809 572 390 823 498 109

+183 +409 +850 +986 +904 +670 +987 +290 +809

321 321 654 657 987 513 214 894 891

+895 +798 +585 +878 +478 +363 +265 +238 +665

878 782 749 729 710 984 709 237 562

+639 +887 +268 +716 +898 +417 +297 +987 +597

728 917 981 232 987 394 823 697 298

+649 +812 +981 +198 +123 +987 +259 +856 +398

798 346 982 309 847 239 823 475 348

+276 +578 +347 +736 +209 +391 +875 +187 +676

519 198 239 809 189 938 454 368 723

+587 +459 +869 +158 +295 +687 +986 +983 +287

368 756 875 387 598 759 837 598 678

+653 +456 +215 +214 +512 +255 +536 +478 +785

807 758 583 287 289 398 598 453 279

+598 +238 +775 +928 +387 +592 +837 +598 +275

872 986 798 276 982 679 823 759 823

+759 +832 +759 +329 +587 +298 +572 +398 +769

The Source for Executive Function Disorders 120 Copyright © 2003 LinguiSystems, Inc.
 Math Equations 3-Digit Subtraction

824 761 917 698 687 918 549 162 487

–812 –740 –875 –515 –580 –128 –274 –118 –264

985 889 723 872 186 243 983 498 873

–549 –872 –348 –661 –175 –231 –673 –249 –340

904 670 987 498 809 819 971 442 809

–572 –390 –823 –290 –106 –809 –875 –346 –598

987 513 363 894 891 798 721 864 993

–478 –363 –265 –238 –665 –789 –697 –584 –874

842 984 709 237 862 698 536 987 397

–898 –417 –297 –112 –597 –529 –198 –287 –268

987 694 823 997 998 572 938 387 814

–123 –487 –259 –656 –282 –398 –237 –129 –644

847 339 923 475 548 724 887 853 763

–209 –291 –175 –187 –376 –325 –390 –235 –609

289 938 854 768 623 762 657 824 936

–195 –687 –486 –383 –287 –587 –312 –641 –687

598 759 837 598 778 938 764 623 674

–512 –255 –536 –478 –685 –746 –355 –263 –645

389 598 898 553 279 983 754 879 823

–287 –392 –537 –498 –275 –282 –375 –382 –759

982 679 823 759 823 859 823 579 820

–587 –298 –572 –398 –769 –126 –798 –489 –658

The Source for Executive Function Disorders 121 Copyright © 2003 LinguiSystems, Inc.
 Auditory Attention Words 1

words lamp the today

attic for when the
memory clock magazine our
live write build cast
on doll first sink
where for travel celebrate
for cookie for this
today in of clock
orders this had face
quality the for including
since for idea for
for collectible was different
hours does the for
the the for roar
value the legend sound
day for by frame
service some for the
guide show the light
the from move for
cover for to color
items photos design with
love three the create
telephone back so for

The Source for Executive Function Disorders 122 Copyright © 2003 LinguiSystems, Inc.
 Auditory Attention Words 2

throw future just along

that the for the
for set want healthy
to little office diet
room from on could
machine lamp for really
yours the when for
truly light find he
antique for for right
style sound that now
camp and stick where
the wheels with should
for spring after the
statement touch few for
buttons wood the feel
the base ago good
soft glass had can
this for for give
learn complete lower any
why accent my information
breath use doctor when
grow weather about prune
most the said for

The Source for Executive Function Disorders 123 Copyright © 2003 LinguiSystems, Inc.
 Auditory Attention Words 3

large pinch the love

easy the statue right
fact tips stone edge
lot runners moss because
month them for child
excellent for winter for
shorten our journal the
the the my favorite
for front the parents
side has friend the
growing privacy porch for
main yard for return
for over out coming
cane take the gathering
six not driving up
the will through that
each the for for
remove that the watch
tangled kind for black
the of once purple
growth line the season
summer along told looking
for thinking the for

The Source for Executive Function Disorders 124 Copyright © 2003 LinguiSystems, Inc.
 Auditory Attention Numbers 1

1 2 6 4 4 3 4 1 6 7 9 8 4
9 7 5 2 6 2 6 7 5 7 2 9 7
5 7 5 9 1 8 5 0 8 5 6 2 7
6 9 8 2 7 6 9 4 6 8 0 9 6
2 0 2 7 9 8 7 1 6 8 8 7 1
9 8 5 0 9 6 0 9 2 8 6 7 5
9 8 3 1 5 9 8 1 7 9 0 1 7
4 9 8 1 2 7 9 8 9 5 8 0 9
3 2 8 6 0 9 8 6 8 9 2 7 5
9 8 1 7 2 4 7 1 9 8 4 0 1
9 2 5 0 9 3 8 6 0 9 2 8 2
5 9 8 7 2 9 8 5 9 8 2 5 7
9 8 2 5 6 0 9 3 6 0 4 9 0
5 9 0 5 4 0 7 5 0 9 6 8 3
9 0 8 9 8 1 7 9 8 1 4 9 1
7 4 9 8 1 0 5 9 2 0 6 9 4
3 6 9 5 9 7 0 5 9 7 0 5 0
9 3 5 0 2 9 9 2 0 3 8 3 9
0 8 5 9 0 8 2 7 9 8 2 7 8
9 1 2 4 8 1 7 4 9 0 8 7 2
9 8 7 9 8 6 8 4 0 9 3 8 6
0 3 8 7 0 9 6 0 3 4 9 5 9
3 7 4 9 8 5 7 2 8 5 4 2 5

The Source for Executive Function Disorders 125 Copyright © 2003 LinguiSystems, Inc.
 Auditory Attention Numbers 2

52 75 73 65 46 53 51 33 54 98 27 64 65
45 17 65 68 47 89 77 68 50 18 56 97 88
54 77 51 56 56 27 58 92 34 12 23 85 92
89 21 82 74 98 27 98 56 98 34 75 99 18
50 92 39 85 79 85 70 91 32 98 75 98 75
89 27 59 89 86 72 98 57 98 10 47 81 65
25 93 27 89 57 29 84 19 82 47 89 75 72
93 85 72 98 57 35 79 83 75 89 83 27 48
21 76 26 58 28 50 43 68 93 99 86 76 57
64 63 62 76 38 79 85 36 79 30 98 90 78
79 44 58 79 45 78 34 74 23 63 28 79 83
24 98 72 29 84 39 87 32 48 52 37 63 46
42 13 64 23 32 46 34 87 98 59 56 35 60
97 93 86 97 69 89 86 78 96 38 76 72 51
54 87 85 98 90 97 19 87 93 79 82 78 71
87 68 79 68 26 46 47 69 85 29 45 81 36
46 75 65 73 28 56 59 51 49 75 68 55 49
42 65 72 74 65 41 56 25 98 56 32 85 68
97 58 97 59 87 62 65 88 96 57 64 23 22
95 21 89 25 23 28 56 24 75 64 28 94 25
92 35 30 42 31 43 26 89 90 57 99 75 57
80 97 50 97 52 65 90 65 28 59 81 27 50
98 27 19 80 74 98 17 50 16 57 86 10 98

The Source for Executive Function Disorders 126 Copyright © 2003 LinguiSystems, Inc.
 Auditory Attention Numbers 3

571 980 579 819 824 761 875 698 570 918 549 118 264

801 658 701 209 812 740 917 515 687 128 274 162 487

164 875 834 984 985 872 348 723 175 231 673 249 873

890 986 596 298 549 889 723 872 186 243 983 498 340

585 109 920 809 572 390 823 498 109 819 871 209 809

183 409 850 986 904 670 987 290 809 809 875 346 598

321 321 654 657 987 513 214 894 891 789 156 167 819

895 798 585 878 478 363 265 238 665 798 697 584 874

878 782 749 729 710 984 709 237 562 465 236 987 397

639 887 268 716 898 417 297 987 597 529 898 287 268

728 917 981 232 987 394 823 697 298 572 938 187 614

649 812 981 198 123 987 259 856 982 398 237 329 844

798 346 982 309 847 239 823 475 348 724 387 253 763

276 578 347 736 209 391 875 187 676 325 890 835 609

519 198 239 809 189 938 454 368 723 762 357 624 736

587 459 869 158 295 687 986 983 287 587 612 641 687

368 756 875 387 598 759 837 598 678 938 764 623 645

653 456 215 214 512 255 536 478 785 746 355 263 674

807 758 583 287 289 398 598 453 279 983 754 379 823

598 238 775 928 387 592 837 598 275 982 375 982 759

872 986 798 276 982 679 823 759 823 759 823 579 820

759 832 759 329 587 298 572 398 769 826 798 489 658

798 798 376 982 759 828 176 287 965 937 690 878 794

The Source for Executive Function Disorders 127 Copyright © 2003 LinguiSystems, Inc.
 Auditory Attention Numbers 4

8709 6893 8769 8275 1864 3758 9772 3986 7907 6893 7983 5782 4872

6415 7681 7945 8973 7417 4590 8213 3175 3247 9827 5810 4712 1893

4798 2497 4981 3379 8123 7509 8432 5798 3769 7859 8210 9816 6632

7892 3526 5367 2357 2376 1521 8964 8728 9127 6293 5793 7097 1965

7809 4578 4096 5983 2324 6832 6832 4683 2498 7345 9865 8873 6428

7438 7257 8912 9781 3268 9213 6835 6786 5379 8798 7609 2697 8329

8732 9782 3198 3142 6327 9843 9873 5985 7235 9872 4835 7290 3579

8023 7590 8327 5902 3750 9819 2189 1628 4618 2648 2713 6405 7097

3693 8693 8609 7468 9269 8561 8712 6487 1264 5057 9230 6579 3679

8237 5980 4718 7648 9768 4761 8757 2935 7981 7498 2374 1748 7237

2387 4321 8698 7352 4069 2498 6239 8050 9385 7982 6187 6879 8987

5206 5982 9804 7810 9980 1741 2987 4321 9872 3176 2317 6213 1614

2738 7589 9086 5890 6598 7528 1912 7621 4732 2984 5876 9869 8769

8568 9798 6836 7236 4827 4367 8236 1563 5162 5312 7645 3723 6487

3589 8679 5870 9587 9476 1857 8365 7832 1157 6517 6156 5387 7689

4686 5097 8065 7980 8604 9093 9834 7598 3759 8379 6274 9826 4981

7481 1981 2201 6129 3805 8792 3578 9876 8923 7489 1200 1984 7238

7243 2398 3279 8432 7234 1223 4869 8739 8434 9052 9097 5298 3759

7895 7598 2562 8745 1256 7324 5724 8727 2670 9367 9275 3827 9275

9801 8764 8712 6872 1364 7905 1205 7989 8570 7217 3086 4829 1364

1027 9875 9990 3798 5439 7250 9750 7902 8574 3298 7239 1857 2908

7259 8035 7902 8371 2787 9811 6891 6498 7298 5896 7896 4509 8627

1982 7239 8406 5287 3658 7659 8047 6093 4798 1261 8687 7627 9798

The Source for Executive Function Disorders 128 Copyright © 2003 LinguiSystems, Inc.
 Auditory Attention Names 1

Lucille Kathleen Steve Mary Frances

Michael Mary Genevieve Michael Tom
Alexander Rita Frank Peter Robert
Lillian Samuel William Irene Augustine
Jane Betty Fred Veronica Henry
Esther Bea Harry Ethel Norman
Mary Michael John Michael Stanley
Dennis Tom Mary Adam Michael
John Robert Margot Richard Mary
Henry Henry Henry Gale Virginia
Kyle Joseph Gerald Ralph Mary
Robert Mildred Michael Kenneth Caroline
Ray John Frank Harriet Maxwell
Howard Edward Wallace Mary Angelina
Michael Joyce Joseph Michael Daniel
Caroline Bernie Florence Ethel Ann
Frederick John Daniel Harry Marty
Helen Bessie Patrick Dwight Edward
Mary Michael Gregory Grover Helen
Bernadine Helena Mary Rudolf Michael
Mary Susan Joe Ben Thomas
Joseph James Pauline Alex Mary
Edwin William Michael Esther Grace
Thomas Elizabeth Veronica Joseph Helen
Max Helen Evelyn Marie Brad
Michael Ed Minnie Louise Julia
Byron Ron Thomas Walter Ruth
Charles Mary Norma Michael Peter
Hugh Eileen William Mary Anthony
James Michael Philip Marshall Roy
Helen Walter Samuel Kevin Harry
Edward Michael Joseph Lillian Vernon

The Source for Executive Function Disorders 129 Copyright © 2003 LinguiSystems, Inc.
 Auditory Attention Names 2

Michael Jerome Helen Natalie Sharon

Richard Dorothy Arthur Ellen Mike
Jeanette Betty Donald Chris David
Mary Mildred Mary Brian Michael
Stella Florence Angeline Ricky Donna
Pauline Michael Sam Sabrina Donna
Bernice Franklin Edward Kelly Mary
Gerald Elijah Michael Alan Kathy
Harry Michael Harold Carrie Pam
Ruth Mary Mary Stephanie Claire
Frances Anna Gertrude Mary Mary
Robert Charlene Anthony Michael Monica
Michael Ross Patricia Rob Steve
Ellen Marie Kate Patty Sally
Kenneth Charles Stanley Connie Michael
Harriet Jack Mary Janis Louise
Mary Michael Cy Katie Karen
Ronald Lucille Harry Dick Kendra
Margaret Seymour Norbert Ann Jenny
Jean Mary Michael Connor Mary
Alfred Michael Shirley Sally Laura
Robert Drew Ruth Todd Michelle
Philip Mary Julia Susan Jeanne
Gerald Marcella Stella Lauren Laurie
Michael John Joyce Michael Megan
William Patrick George Charlotte Tina
John Eleanor Adeline Mary Michael
Maurice Michael Laverne Christie Diane
Anna Ted Sophie Tom Ryan
Mary Douglas Mary Michael Scott
June Ronald Michael Jack Wilma
Rose Dick Samuel Catherine Marion

The Source for Executive Function Disorders 130 Copyright © 2003 LinguiSystems, Inc.
 Auditory Attention Names 3

Mary Brad Alex Jeanne Christopher

Peter Tom Gina Michael Rachel
Sean Jack Michelle Venessa Erin
Sarah Michael Olivia Nell Marley
Jill Stephanie Laura Megan Tina
Joe Kendra Mary Jackie Randy
Mark Mary Mark Bryan Mary
Hillary Katherine Larry Caitlin Michael
Michael Jack Thomas Lucy Nicole
Ellen Samantha Michael Kevin Melanie
Cheryl Mary Matt Joseph Patrick
Lisa Steven Madeline Mary Megan
Christy Jeremy Caroline Spencer Tim
Tom Kyle Mac Joe Christie
Phil Michael Tony Michael Margaret
Kevin Kendra Chloe Eddie Lauren
Mary Thomas Katie Allie Eddie
Grace Julie Malcolm Madeline Christine
Roberto Frank Mary Charlie Michael
Peter Grant Joanne Amanda Mary
Tim Brian Danielle Lara Scott
Patrick Michael Michael Jasmine Darla
Michael Ryan Colleen Molly Bobby
Matthew Mary Nikki Nick Teddy
Billy Max Alexa Mary Luke
Allison Daniel Joey Sarah Cathy
Quinn Karen Andrew Michael Jocelyn
Jonathan Colleen Will Julie Pete
Emily Michael Rebecca Melanie Elena
Mary Jeffrey Monica Neal Lisa
Maggie Rachel Adam Richard Larry
Connor Connor Mary Kathy Maria

The Source for Executive Function Disorders 131 Copyright © 2003 LinguiSystems, Inc.
 Auditory Attention Names 4

Michael Stacey Anita Tom Irene

Dorothy Janis Sam Bud Helene
Mary Sandy Lois Mary Agnes
Karen Dennis Fred Joan Shirley
Jill Betsy Emily Angela Maureen
Louis Michael Judy Shannon Corrine
George Helen Mary Michael Helen
Eileen Dick Nancy Jerome Diana
Patricia Martha Russ Marguerite Mary
Barbara Marvin Felix Audrey John
Oscar Lucille Melissa Rebecca Michael
Daniel Mary Marlene Melvin Leonard
Michael Cesar Michael Carlos James
Juliet Noah Leo Laurie Vince
Gina Harold Vicki Mary Scott
David Loraine Clifford Harold Dean
Mary Michael Dennis Douglas Hector
Sylvia Carlos Alice Michael Gertrude
Josie Michael Rose Judith Ernesto
Rosemarie Alvin Ellen Karen Jennifer
Al Heather Mary Rosie Tyrone
Joe Charles Florence Caroline Mary
Joyce Theresa Sharon Allison Michael
Denise Mary Julie Norm Delores
Paul Phyllis Stanley Samuel Everett
Michael Mario Michael Martha Vivian
Bernadette Cora Dorothy Teresa Beth
Stephen Gladys Barry Mary Sandra
John Cindy Amy Peggy Rita
Mary Albert Tim Michael Victoria
Jan Michael Ken Joy Hilary
Debbie Joan Lyle Donna Annette

The Source for Executive Function Disorders 132 Copyright © 2003 LinguiSystems, Inc.
 Distractions Worksheet

Name: Date:

Task Distractions Present Modifications

The Source for Executive Function Disorders 133 Copyright © 2003 LinguiSystems, Inc.
 Visual Selective Attention

BIG LITTLE big little LITTLE big BIG

LITTLE big LITTLE big little little big
BIG LITTLE big BIG LITTLE big little
little LITTLE big BIG LITTLE big LITTLE
big little BIG LITTLE big LITTLE big
little little big BIG LITTLE big BIG
LITTLE big little little LITTLE LITTLE big
BIG LITTLE big LITTLE big little BIG
LITTLE big LITTLE big little little big
BIG LITTLE big BIG little BIG LITTLE
big LITTLE big little little big BIG
LITTLE big LITTLE big little BIG LITTLE
big LITTLE big little little big BIG
LITTLE big BIG little BIG LITTLE big
LITTLE big little LITTLE big BIG LITTLE
big LITTLE big little little big BIG
LITTLE big BIG LITTLE big little little
big BIG little BIG LITTLE big LITTLE
big little LITTLE BIG BIG LITTLE big
LITTLE big little little big BIG LITTLE
LITTLE big little little big BIG LITTLE
big BIG little BIG LITTLE BIG little
LITTLE big LITTLE big little little big

The Source for Executive Function Disorders 134 Copyright © 2003 LinguiSystems, Inc.
 Visual Selective Attention

Fat Skinny Fat Skinny Fat

Skinny Fat Skinny Fat Skinny
Fat Skinny Fat Skinny Fat
Fat Skinny Fat Skinny Fat
Skinny Fat Skinny Fat Fat
Skinny Fat Skinny Fat Skinny
Fat Skinny Skinny Fat Skinny
Fat Skinny Fat Skinny Fat
Skinny Fat Skinny Fat Skinny
Fat Skinny Skinny Fat Skinny
Skinny Skinny Fat Skinny Fat
Fat Fat Skinny Fat Skinny
Fat Skinny Fat Skinny Fat
Fat Fat Skinny Fat Skinny
Skinny Fat Skinny Fat Fat
Skinny Fat Skinny Fat Skinny
Fat Skinny Fat Skinny Fat
Skinny Fat Skinny Fat Skinny
Fat Skinny Fat Skinny Fat
Skinny Fat Skinny Fat Fat
Fat Skinny Fat Skinny Skinny
Skinny Skinny Fat Skinny Fat
Skinny Fat Skinny Fat Fat
The Source for Executive Function Disorders 135 Copyright © 2003 LinguiSystems, Inc.
 Visual Selective Attention

Print Cursive Print Cursive Cursive Print

Cursive Print Cursive Cursive Print Cursive
Cursive Print Cursive Cursive Cursive Print
Print Cursive Print Cursive Cursive Print
Cursive Print Cursive Cursive Print Cursive
Cursive Print Cursive Cursive Cursive Print
Print Cursive Print Cursive Cursive Print
Cursive Print Cursive Cursive Print Cursive
Cursive Print Cursive Print Cursive Print
Cursive Cursive Print Cursive Print Cursive
Cursive Print Cursive Cursive Cursive Cursive
Print Cursive Cursive Print Cursive Print
Cursive Print Cursive Cursive Print Cursive
Print Cursive Cursive Print Cursive Cursive
Cursive Cursive Print Cursive Cursive Print
Cursive Print Cursive Cursive Print Cursive
Cursive Print Cursive Print Cursive Print
Cursive Cursive Print Cursive Print Cursive
Cursive Print Cursive Cursive Print Cursive
Print Cursive Cursive Print Cursive Print
Cursive Print Print Cursive Cursive Print
Cursive Print Cursive Cursive Print Cursive
Cursive Print Cursive Cursive Cursive Print

The Source for Executive Function Disorders 136 Copyright © 2003 LinguiSystems, Inc.
 Visual Selective Attention

BOLD LIGHT BOLD LIGHT LIGHT BOLD BOLD

LIGHT LIGHT BOLD LIGHT LIGHT LIGHT BOLD
LIGHT BOLD LIGHT LIGHT BOLD BOLD LIGHT
BOLD LIGHT BOLD LIGHT LIGHT BOLD BOLD
LIGHT BOLD LIGHT LIGHT BOLD BOLD LIGHT
BOLD LIGHT BOLD LIGHT BOLD LIGHT LIGHT
LIGHT BOLD LIGHT BOLD LIGHT LIGHT BOLD
BOLD LIGHT BOLD LIGHT BOLD BOLD LIGHT
LIGHT BOLD BOLD LIGHT BOLD LIGHT LIGHT
BOLD BOLD LIGHT BOLD LIGHT BOLD LIGHT
BOLD LIGHT LIGHT LIGHT BOLD LIGHT BOLD
LIGHT BOLD BOLD LIGHT LIGHT BOLD BOLD
LIGHT BOLD LIGHT LIGHT BOLD BOLD LIGHT
BOLD LIGHT LIGHT BOLD BOLD LIGHT BOLD
LIGHT LIGHT LIGHT LIGHT BOLD LIGHT BOLD
LIGHT BOLD BOLD LIGHT LIGHT BOLD BOLD
LIGHT BOLD LIGHT BOLD LIGHT LIGHT BOLD
BOLD LIGHT BOLD LIGHT BOLD LIGHT BOLD
LIGHT LIGHT LIGHT BOLD LIGHT BOLD LIGHT
BOLD BOLD LIGHT BOLD BOLD LIGHT BOLD
LIGHT LIGHT LIGHT LIGHT LIGHT BOLD LIGHT
BOLD LIGHT BOLD LIGHT LIGHT BOLD LIGHT

The Source for Executive Function Disorders 137 Copyright © 2003 LinguiSystems, Inc.
 Task Combination Worksheet

Name: Date:

Appropriate
Tasks Combinations Times Reminders

The Source for Executive Function Disorders 138 Copyright © 2003 LinguiSystems, Inc.
 Alternating Attention Math

52 75 73 65 46 53 51 33 54 98 27 64 65
+45 +17 +65 +68 +47 +89 +77 +68 +50 +18 +56 +97 +88

94 77 81 76 96 27 98 92 94 32 73 95 92
–89 –21 –42 –54 –58 –27 –58 –56 –38 –14 –25 –89 –18

50 92 39 85 79 85 70 91 32 98 75 98 75
+89 +27 +59 +89 +86 +72 +98 +57 +98 +10 +47 +81 +65

95 93 77 99 57 39 84 89 82 87 89 75 72
–23 –85 –22 –88 –57 –25 –79 –13 –75 –49 –83 –27 –48

21 76 26 58 28 50 43 68 93 99 86 76 57
+64 +63 +62 +76 +38 +79 +85 +36 +79 +30 +98 +90 +78

79 94 78 79 85 78 84 74 43 63 68 89 83
–24 –48 –52 –29 –44 –39 –37 –32 –28 –52 –37 –63 –46

42 13 64 23 32 46 34 87 98 59 56 35 60
+97 +93 +86 +97 +69 +89 +86 +78 +96 +38 +76 +72 +51

84 87 85 98 90 97 49 87 93 79 62 88 71
–57 –68 –29 –68 –26 –46 –17 –69 –35 –29 –45 –71 –36

46 75 65 73 28 56 59 51 49 75 68 55 49
+42 +65 +72 +74 +65 +41 +56 +25 +98 +56 +32 +85 +68

97 58 97 59 87 62 65 88 96 67 64 93 51
–95 –21 –89 –25 –23 –28 –56 –24 –75 –34 –28 –24 –25

92 35 30 42 31 43 26 89 90 57 99 75 77
+80 +97 +50 +97 +52 +65 +90 +65 +28 +59 +81 +27 +50

The Source for Executive Function Disorders 139 Copyright © 2003 LinguiSystems, Inc.
 Alternating Attention Math

92 97 50 97 52 65 90 89 90 59 99 75 77
+80 –35 +30 –42 +31 –43 +26 –65 +28 –57 +81 –27 +50

52 75 73 68 47 89 77 68 54 98 56 97 88
–45 +17 –65 +15 –34 +53 –51 +33 –50 +18 –27 +64 –65

89 77 82 74 98 27 98 92 48 34 75 99 92
+54 –21 –51 +56 –56 +27 –58 +56 –14 +12 –23 +85 –18

89 92 59 89 86 85 98 91 98 98 75 98 75
+50 –27 +39 –59 +79 –72 +70 –57 +32 –10 +47 –81 +65

93 93 72 98 57 35 84 83 82 89 89 75 72
–25 +85 –27 +89 –57 +29 –79 +19 –75 +47 –83 +27 –48

64 76 62 76 38 79 82 68 93 99 98 90 78
+21 –63 +26 –58 +28 –50 +43 –36 +79 –30 +86 –76 +57

79 98 72 79 84 78 87 74 48 63 37 79 83
–24 +44 –58 +29 –49 +39 –34 +32 –23 +52 –28 +63 –46

99 57 86 97 69 89 86 87 98 59 76 72 60
+97 –43 +64 –23 +32 –46 +34 –78 +66 –38 +56 –35 +51

87 87 85 98 90 97 47 87 93 79 82 81 71
–54 +68 –79 +68 –26 +46 –19 +69 –85 +29 –45 +78 –36

46 75 72 74 65 56 59 51 98 75 68 85 68
+42 –65 +65 –24 +28 –41 +36 –25 +49 –56 +32 –55 +49

97 58 97 59 87 62 65 88 96 57 64 94 25
–95 +21 –89 +25 –23 +28 –56 +24 –75 +64 –28 +23 –22

The Source for Executive Function Disorders 140 Copyright © 2003 LinguiSystems, Inc.
 Alternating Attention Math

50 72 39 85 79 85 70 89 32 98 75 98 75
+89 –27 x9 +89 +86 x7 –61 x6 –11 +22 +27 –30 –42

63 22 45 92 73 61 68 50 27 31 42 50 22
+65 x7 x2 +36 –27 +55 +43 –28 x6 –28 +27 +68 –18

48 98 33 57 52 98 82 68 84 62 98 90 87
+21 –63 x6 x8 +28 –50 +43 –26 +79 –30 x6 –76 x7

79 56 83 25 92 78 87 65 32 61 87 79 83
x4 +44 –58 +29 –49 x9 x4 +32 –23 –52 +28 +63 x6

69 95 86 85 34 67 68 67 98 68 76 72 50
+27 –43 x4 –23 +32 x4 x3 –16 x6 –38 +56 x3 +51

87 87 85 98 80 17 47 87 93 79 72 81 61
–54 –68 –79 +68 x6 x3 –19 +69 –85 +39 –45 +68 x6

46 75 72 64 55 56 69 51 98 75 68 58 68
x4 x5 –65 +24 +28 –41 x6 x5 –49 –56 +32 x2 x9

87 48 67 59 87 62 65 78 46 50 64 94 25
–59 +21 –28 x2 x8 +28 –36 +24 –24 x9 –28 +23 –22

54 68 32 57 93 47 56 31 17 27 48 62 91
x7 –32 +34 +20 -54 x7 x6 +54 -10 +27 -29 x4 x3

64 27 31 12 88 73 41 53 67 89 19 42 77
+84 x6 x9 +82 -12 x7 x6 +43 +19 -71 +73 x2 +63

The Source for Executive Function Disorders 141 Copyright © 2003 LinguiSystems, Inc.
 Simultaneous Tasks Worksheet

Name: Date:

Simultaneous Tasks Problems Modifications

The Source for Executive Function Disorders 142 Copyright © 2003 LinguiSystems, Inc.
 Divided Attention Activities Odd/Even 1

Odds Evens
1 2 6 4 4 3 4 1 6
7 9 8 4 9 7 5 2 6
2 6 7 5 7 2 9 7 5
7 5 9 1 8 5 0 8 5
6 2 7 6 9 8 2 7 6
9 4 6 8 0 9 6 2 0
2 7 9 8 7 1 6 8 8
7 1 9 8 5 0 9 6 0
9 2 8 6 7 5 9 8 3
1 5 9 8 1 7 9 0 1
7 4 9 8 1 2 7 9 8
9 5 8 0 9 3 2 8 6
0 9 8 6 8 9 2 7 5
9 8 1 7 2 4 7 1 9
8 4 0 1 5 9 8 1 7
9 0 1 7 4 9 8 1 2
9 8 9 5 8 0 9 3 8
9 2 7 5 9 8 1 7 2
4 7 1 9 8 4 0 1 5
8 0 9 3 8 2 7 5 9
8 1 7 2 4 7 1 9 8

The Source for Executive Function Disorders 143 Copyright © 2003 LinguiSystems, Inc.
 Divided Attention Activities Odd/Even 2

Odds Evens
52 75 73 65 46 53 51 33 54
98 27 64 65 45 17 65 68 47
89 77 68 50 18 56 97 88 54
77 51 56 56 27 58 92 34 12
23 85 92 89 21 82 74 98 27
98 56 98 34 75 99 18 50 92
39 85 79 85 70 91 32 98 75
98 75 89 27 59 89 86 72 98
57 98 10 47 81 65 25 93 27
89 57 29 84 19 82 47 89 75
72 93 85 72 98 57 35 79 83
75 89 83 27 48 21 76 26 58
28 50 43 68 93 99 86 76 57
64 63 62 76 38 79 85 36 79
30 98 90 78 79 44 58 79 45
78 34 74 23 63 28 79 83 24
98 72 29 84 39 87 32 48 52
37 63 46 42 13 64 23 32 46
34 87 98 59 56 35 60 97 93
86 97 69 89 86 78 96 38 76
72 51 78 79 44 58 79 45 78

The Source for Executive Function Disorders 144 Copyright © 2003 LinguiSystems, Inc.
 Divided Attention Activities Odd/Even 3

Odds Evens
980 579 819 824 761 875 698 570 918

549 118 264 801 658 701 209 812 740

917 515 687 128 274 162 487 164 875

834 984 985 872 348 723 175 231 673

249 873 890 986 596 298 549 889 723

872 186 243 983 498 340 585 109 920

809 572 390 823 498 109 819 871 209

809 183 409 850 986 904 670 987 290

809 809 875 346 598 321 321 654 657

987 513 214 894 891 789 156 167 819

895 798 585 878 478 363 265 238 665

798 697 584 874 878 782 749 729 710

984 709 237 562 465 236 987 397 639

887 268 716 898 417 297 987 597 529

898 287 268 728 917 981 232 987 394

823 697 298 572 938 187 614 649 812

981 198 123 987 259 856 982 398 237

329 844 798 346 982 309 847 239 823

475 348 724 387 253 763 276 578 347

736 209 391 875 187 676 325 890 835

609 519 198 239 809 189 938 454 368

The Source for Executive Function Disorders 145 Copyright © 2003 LinguiSystems, Inc.
 Divided Attention Activities Homonyms 1

accident bend cabinet contact

account bill calf corn
act bit can count
admit blank cap counter
appreciate block case court
arm blow cast cover
ash blue center crab
average bluff change crack
back board channel crane
bail boil charge creep
ball bolt charm cricket
band bore check critical
bangs boss chest crop
bank bow china cross
bar bowl chip curb
bark box chop dampen
base brake class dart
baste brand clip dash
bat brick club date
batter bridge clutch deal
beam brief coat deck
bear buck cold decline
beat buckle colon dip
bed bug company direction
bell bump complex dock
belt cable concentration down

The Source for Executive Function Disorders 146 Copyright © 2003 LinguiSystems, Inc.
 Divided Attention Activities Homonyms 2

draft flat hail lace

draw float ham land
dress flounder hamper lap
drill flush hand last
drop fly hard lean
duck foil harp leaves
dull fool hatch left
ear foot haze letter
egg fork head lie
elder foul hide light
endorse frame hike like
engage free hit limb
eye fret hood line
face fudge host lip
fair game ice loaf
fall gear incline lock
fan general iron lodge
fast glasses jack log
felt grade jam long
file grate jar lounge
film graze jerk maroon
fine grease judge mask
finish green key mass
fire grill kid match
firm groom kind mate
fit ground knock mean
flag gum knot meet

The Source for Executive Function Disorders 147 Copyright © 2003 LinguiSystems, Inc.
 Divided Attention Activities Homonyms 3

might period press roast

milk permit prime rock
mine pet prop room
mint physical prune rose
miss pick punch round
mold pinch pupil row
mole pit purse ruler
mug pitch quack run
nail pitcher quality rung
nap place quarter runner
negative plain race safe
novel plane racket sage
nut plant range saw
orange plate rare scale
order play rash school
organ plot rate seal
pack poach rattle season
page point rear second
palm poker record select
panel pole reflect sentence
pants pool refrain set
park pop relish shake
part port report share
pass position rest sharp
patient positive rich shed
pen post right sheet
perch pound ring shock

The Source for Executive Function Disorders 148 Copyright © 2003 LinguiSystems, Inc.
 Divided Attention Activities Homonyms 4

shop stalk tap watch

short stall tape wave
shot stamp temple well
sight stand tense whip
sign staple tick will
sink star tie yard
slide state tip
slip stay tire
slug steer toast
snap stick toll
soil still top
sole stock toy
solution strain track
sound strand trail
space straw train
spade strike truck
spare strip trunk
speaker stroke tumbler
spell stump tune
spoke sty turkey
spot submarine turn
spring suspect type
square swallow uniform
squash switch utter
stable tag vault
staff tail vice
stage tank wake

The Source for Executive Function Disorders 149 Copyright © 2003 LinguiSystems, Inc.
 Divided Attention Activities Trail Activity 1

Begin with the letter A and draw a line to the number 1. Continue by drawing a line to B, then
2, and so on, alternating letters and numbers, in order.

A
I
E
6 5 J
B

F
1
7
8
D
3 10

4 G
C 9
H 2
The Source for Executive Function Disorders 150 Copyright © 2003 LinguiSystems, Inc.
 Divided Attention Activities Trail Activity 2

Begin with the letter A and draw a line to the number 1. Continue by drawing a line to B, then
2, and so on, alternating letters and numbers, in order.

4
A
F
H
J D
1
8
9
2 G
I
E 10
5
7
C 6

3 B
The Source for Executive Function Disorders 151 Copyright © 2003 LinguiSystems, Inc.
 Divided Attention Activities Trail Activity 2

Begin with the number 1 and connect all the odd numbers in order. Then connect the highest
odd number to the lowest even number and connect all the even numbers in order.

16
4 11
13
14
17
1
8
9
2
15
20
10
5
12 7
6

3 19 18
The Source for Executive Function Disorders 152 Copyright © 2003 LinguiSystems, Inc.
 Divided Attention Activities Trail Activity 2

Begin with the number 1 in the square and connect it to the number 1 in the circle. Connect the
number 1 in the circle to the number 2 in the square and continue connecting numbers in order,
alternating between the same number in the two different shapes.

3
4 1
8
9
7 4
8
9
2 6
1
2
5
10 7
6

3 10 5
The Source for Executive Function Disorders 153 Copyright © 2003 LinguiSystems, Inc.
 Divided Attention Activities Rule Shift List

Only red cards Only odd clubs

Only black cards Only even hearts

Only even cards Only odd hearts

Only odd cards Only even diamonds

Only face cards Only odd diamonds

Only female face cards Only even red and odd black cards

Only male face cards Only odd red and even black cards

Only spades Only spades and hearts

Only clubs Only spades and diamonds

Only hearts Only clubs and hearts

Only diamonds Only clubs and diamonds

Only even red cards Only even cards and face cards

Only odd red cards Only odd cards and face cards

Only even black cards Only red cards and Queens

Only odd black cards Only black cards and Queens

Only even spades Only even cards and Kings

Only odd spades Only odd cards and Kings

Only even clubs Only Aces and 2s

The Source for Executive Function Disorders 154 Copyright © 2003 LinguiSystems, Inc.
 Treatment

Plan–Execute–Repair

T he essence of executive functions may be expressed in three

words: Plan–Execute–Repair. These words will become a
mantra for patients. Patients will learn to ask themselves the follow-
ing questions as they move through the Plan-Execute-Repair phases:
➤ Plan: What am I trying to accomplish?
➤ Plan: What are the necessary steps?
➤ Plan: What is the sequence of these steps?
➤ Plan: How long will each step take?
➤ Plan/Execute: How and when do I start?
➤ Execute: How will I persevere with the task?
➤ Execute/Repair: What could possibly go wrong?
➤ Repair: How is my plan moving along? Do I need to alter the plan?
➤ Execute: How will I know when I’m finished?
➤ Repair: What would I do differently next time?
➤ Repair: What would I do the same next time?

A personal organizational system will play an

Helpful Hint: Business publications often contain important role in the Plan-Execute-Repair
articles and forms on project manage- phase. Each target task will be housed in the
ment that can be kept as examples
system where it is easily located for frequent
and shared with patients.
use. Some organizational systems come with
their own project management sections and
forms but others do not. Provide the patient with the Planning Form
on page 166 if needed. An example is shown on the next page.

The Source for Executive Function Disorders 155 Copyright © 2003 LinguiSystems, Inc.
 Plan–Execute–Repair

Planning Form
“Plan” Phase:
What am I trying to accomplish? Task:
Have Bob’s birthday gift ready by Saturday evening.

➤ Begin with a well-defined task that has an explicit

end result and straightforward steps toward this Steps
Completion
Schedule ✔ Feedback
result. Employ the patient’s schedule and to-do
lists to determine an appropriate task. Consider
Phase 7 (Prioritizing) of Time Management in
selecting a task.
➤ Have the patient clearly state the goal and write it
in the “Task” box. For example, what appears in
the organizational system as “Bob’s Birthday”
should be refined to “Have Bob’s birthday gift ready
by Saturday evening.” Ask the patient to write the
specific task, which is the end result, in the organi-
zational system.

“Plan” Phase:
What are the necessary steps?
➤ Have the client work backwards from the desired
end result and pick out each individual step involved in reaching the goal.
Focus on writing as many options and ideas as possible. Here are some sample
steps to consider:
• Wrap gift.
• Buy gift.
• Go to the store.
• Schedule time to go to the store.
• Brainstorm gift ideas.
• Decide on a budget.

➤ Each of the steps listed above has ancillary components that need to be listed:
1. Wrap gift.
✔ Have wrap, ribbon, box, and tape on hand.
✔ Shop if these supplies are unavailable.
✔ Schedule time to shop.
2. Buy gift.

The Source for Executive Function Disorders 156 Copyright © 2003 LinguiSystems, Inc.
 Plan–Execute–Repair

3. Go to the store.
✔ Drive, park, shop, check out, and drive home.
✔ Have money — go to the bank.
• Schedule time to go to the bank.
4. Brainstorm gift ideas.
✔ Look online — check delivery times and fees.
✔ Look in catalogs — check delivery times and fees.
✔ Look around at the mall.
• Schedule time to go to the mall.
✔ Talk to friends about ideas.
• Schedule time to talk to friends.
5. Decide on a budget.
✔ Balance checkbook.

What appeared on paper to be a single activity, “Bob’s birthday,” is actually a 15-20

step process. Patients with executive function disorders fail to recognize all the com-
ponents of the task and, therefore, fail to schedule adequate time to complete each of
the steps.

The most appropriate treatment tasks for identifying specific steps of a larger task
are found within the patient’s real-life activities. Once meaningful activities have
been identified, manipulate the difficulty of this phase by doing the following:

➤ Identifying Critical Steps: Provide the patient with a variety of steps, both
critical and unrelated to the target task and ask the patient to identify which
steps are components of the target task and which are not. For example, pro-
vide the patient with these steps and ask him or her to identify which ones are
related to “having Bob’s birthday gift ready by Saturday evening”:
• deciding on a budget
• getting gasoline for the car
• shopping for the gift
• wrapping the gift
• baking a cake
• looking for decorations

➤ Critical Step Omission: Provide the patient with a variety of steps related to
the target task, omit several key components, and ask the patient to identify the
missing steps. On the following page is an incomplete list of steps for buying
and wrapping a birthday gift. Have your patient fill in the missing steps.

The Source for Executive Function Disorders 157 Copyright © 2003 LinguiSystems, Inc.
 Plan–Execute–Repair

1. Wrap gift.
✔ Have wrap, ribbon, box, and tape on hand.
✔ ___________________________________________________________
✔ ___________________________________________________________
2. Buy gift.
3. Go to the store.
✔ ___________________________________________________________
✔ Have money — go to the bank.
• Schedule time to go to the bank.
4. Brainstorm gift ideas.
✔ Look online — check delivery times and fees.
✔ ___________________________________________________________
✔ Look around at the mall.
• Schedule time to go to the mall.
✔ ___________________________________________________________
• Schedule time to talk to friends.
5. Decide on a budget.
✔ ___________________________________________________________

➤ Critical Step Generation: Provide the patient with the target task and the
number of steps and sub-steps involved in outline form. Then have the patient
fill in the steps.
Task: Buying a birthday gift
1. _____________________________________________________________
✔ ___________________________________________________________
✔ ___________________________________________________________
✔ ___________________________________________________________
2. _____________________________________________________________
3. _____________________________________________________________
✔ ___________________________________________________________
✔ ___________________________________________________________
• ________________________________________________________
4. _____________________________________________________________
✔ ___________________________________________________________
✔ ___________________________________________________________
✔ ___________________________________________________________
• ________________________________________________________

The Source for Executive Function Disorders 158 Copyright © 2003 LinguiSystems, Inc.
 Plan–Execute–Repair

✔ ___________________________________________________________
• ________________________________________________________
5. _____________________________________________________________
✔ ___________________________________________________________

Occasionally patients will require more clinical practice to master the ability to
generate all the steps of a task. Specific practice examples are provided on the
Task Steps Activities on pages 167-170.

Planning Form “Plan” Phase:

What is the sequence of these steps?
Task: Have Bob’s birthday gift ready by Saturday evening.
The next task is to decide on the order of the
steps needed to accomplish the goal. Have
Completion the patient consider which steps need to be
Steps Schedule ✔ Feedback completed prior to others. Encourage the
Balance checkbook. patient to combine steps when appropriate,
Decide budget.
such as shop for gift wrap during the same
time as shopping for the gift.
Schedule time to go to the
mall.

Schedule time to talk to Again, the most appropriate treatment

friends.
tasks for specific step sequences are found
Look in catalogs—check
delivery times and fees. within the patient’s real-life activities. The
Look online—check delivery
times and fees.
level of difficulty for sequencing can be
Look around at the mall. manipulated by doing the following:
Talk to friends about ideas.
➤ Critical Step Omission: Provide the
patient with a variety of steps related to
Schedule time to go to the
bank. the target task, omit several key compo-
Go to the bank. nents, and ask the patient to identify the
Drive to the store and park.
missing steps.
Shop and check out—ask for ➤ Critical Step Generation: Provide the
a box.
patient with the target task and the num-
Buy wrap and ribbon.
ber of steps and sub-steps involved in out-
Drive home. line form. Then have the patient fill in
Wrap gift.
the steps.

The Source for Executive Function Disorders 159 Copyright © 2003 LinguiSystems, Inc.
 Plan–Execute–Repair

There are many available activities to address sequencing in isolation:

➤ letters into words
➤ words into sentences
➤ sentences into paragraphs
➤ number patterns

Occasionally patients will require more clinical practice to master sequencing of

steps in functional activities. Examples are provided in the Task Sequencing
Activities on page 171.

The end product, steps, and the sequence of the steps should be clearly written in the
patient’s organizational system and carried with the patient. This provides a “blue-
print” of the plan.

Planning Form
“Plan” Phase:
How long will each step take? Task: Have Bob’s birthday gift ready by Saturday evening.

Utilize the Time Estimation Worksheet

on page 72 if the patient has not yet mas- Completion
✔
tered this skill. Have the patient analyze
Steps Schedule Feedback

the time requirements for every step and Balance checkbook. 15 minutes

calculate the total time needed to complete Decide budget. 3 minutes

the task, as in the example on the right. Schedule time to go to the 5 minutes
mall.

Schedule time to talk to with above

friends.

“Plan” and “Execute” Phases: Look in catalogs—check

delivery times and fees.
15 minutes

How and when do I start? Look online—check delivery 30 minutes

times and fees.

Once the length of time each step will take Look around at the mall. 20 minutes

has been established, begin to work with the Talk to friends about ideas. 20 minutes
patient in determining where that time is
available in the schedule. For example, if Schedule time to go to the
bank.
with third item

shopping will take 2 hours, but the patient Go to the bank. 20 minutes

doesn’t have 2 hours free the several days

Drive to the store and park. 10 minutes
prior to the due date, this dilemma needs to
be known prior to the day before the due Shop and check out—ask for 30 minutes
a box.
date. Once times are slotted, the patient will Buy wrap and ribbon. with above
then write component steps into his or her
daily and weekly schedule and on daily and Drive home. 10 minutes

weekly to-do lists. The example on the next Wrap gift. 10 minutes

page includes these considerations.

The Source for Executive Function Disorders 160 Copyright © 2003 LinguiSystems, Inc.
 Plan–Execute–Repair

Determining the exact date and time to

Planning Form
begin, combined with dividing the target
Task: Have Bob’s birthday gift ready by Saturday evening.
task into smaller, manageable components,
can help break the inertia frequently
described by patients with executive func-
Completion tion disorders. Instruct the patient to check
✔
Steps Schedule Feedback
off each step when it is accomplished.
Balance checkbook. 15 minutes
Sunday afternoon

Decide budget. 3 minutes The Time Estimation Worksheet on page

Sunday afternoon
72 is useful initially. Have the patient use a
Schedule time to go to the 5 minutes
mall. Monday morning clock or watch alarm as a reminder of when
Schedule time to talk to
friends.
with above to start or stop an activity.
Look in catalogs—check 15 minutes
delivery times and fees. Monday evening Utilizing the patient’s target tasks and
Look online—check delivery
times and fees.
30 minutes
Monday evening schedules is the most effective form of prac-
Look around at the mall. No time—omit tice. Occasionally, patients will require
Talk to friends about ideas. 20 minutes
more structured practice. Task Sequenc-
Wed. afternoon ing Activities can be found on page 171
Schedule time to go to the
bank.
with third item
Monday morning
and Task Combination Activities are on
Go to the bank. 20 minutes page 172.
Leave Fri. 5:00pm

Drive to the store and park. 10 minutes

Friday

Shop and check out—ask for 30 minutes

a box. Friday

Buy wrap and ribbon. with above

Friday
“Execute” Phase:
Drive home. 10 minutes
How will I persevere with the task?
Fri. 8:00pm

Wrap gift. 10 minutes What are the requirements of attention for

Sat. 3:00 pm
each step of the process? Ask the patient to
analyze each step for possible challenges to
each level of attention.

➤ Does any step require the patient to pay attention for a longer period of time
than he or she is capable of? If so, the patient will need to break the step into
multiple phases.
➤ Does any step tax the patient’s selective attention? Are there distractions that
can be minimized or eliminated prior to initiating the step?
➤ Does any step require the patient to divide or alternate attention beyond per-
sonal limits?

The example on the next page displays some of the challenges mentioned above and
presents ways to address them.

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 Plan–Execute–Repair

Planning Form

Task: Have Bob’s birthday gift ready by Saturday evening.

Completion
Steps Schedule ✔ Feedback

Balance checkbook. 15 minutes

Need Silence Sunday afternoon

Decide budget. 3 minutes

Sunday afternoon

Schedule time to go to the 5 minutes

mall. Monday morning

Schedule time to talk to with above

friends.

Look in catalogs—check 15 minutes

delivery times and fees. Monday evening

Look online—check delivery 30 minutes

times and fees. Monday evening
Set alarm to limit to 30
minutes.

Talk to friends about ideas. 20 minutes

Wed. afternoon

Schedule time to go to the with third item

bank. Monday morning

Go to the bank. 20 minutes

Leave Fri. 5:00pm

Drive to the store and park. 10 minutes

Friday

Shop and check out—ask for 30 minutes

a box. Buy wrap and ribbon. Friday
Keep list handy to stay on
track.

Drive home. 10 minutes

Fri. 8:00pm

Wrap gift. 10 minutes

Sat. 3:00 pm

“Execute” and “Repair” Phases:

What could possibly go wrong?
A complete list of pitfalls for any task could be immense! Instead, have your patient
stick with the most likely interferences and anticipate ways to work through them.
Here are some examples:
➤ The wanted gift was not available for 2 weeks:
• Decide this is the perfect gift and give Bob an “IOU” due in two weeks.
• Find a different gift.
➤ The item doesn’t fit in the box available:
• Buy many different-sized boxes at once.
• Use a gift bag instead.

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 Plan–Execute–Repair

➤ Your car is scheduled for repairs the week you plan to shop for Bob’s gift:
• Change shopping schedule.
• Change car repair appointment.
• Borrow or rent a car for the day.
• Take public transportation.
✔ Does it go where you need to go? Can you shop elsewhere?

Have the patient modify the schedule to allow for the likely interruptions and sched-
ule backup plans.

Planning Form
“Repair” Phase:
Task: Have Bob’s birthday gift ready by Saturday evening. How is my plan moving along? Do I need
to alter the plan?
Completion Continuous analysis of the plan, its steps,
Steps Schedule ✔ Feedback
and the sequence is mandatory. The patient
Balance checkbook.
Need Silence
15 minutes
Sunday afternoon
needs to be in the repair phase throughout,
Decide budget. 3 minutes
asking questions such as these:
Sunday afternoon

Schedule time to go to the 5 minutes

➤ Is the end product still the same?
mall. Monday morning

Schedule time to talk to with above

➤ Are there additional steps?
friends.
➤ Can some steps be eliminated?
Look in catalogs—check 15 minutes Bob said he has trouble with returns not in
delivery times and fees. Monday evening town—don’t use catalogs.
➤ Is the schedule the same?
Look online—check delivery 30 minutes Got off task looking at other items not
times and fees. Monday evening related to gift—consider less than 30
Set alarm to limit to 30 minutes and use a louder alarm.
minutes. Barriers often appear that prevent the
Talk to friends about ideas. 20 minutes patient from completing the task as originally
Wed. afternoon

Schedule time to go to the with third item

scheduled. Mental flexibility (discussed in
bank. Monday morning the previous chapter) will allow the patient to
Go to the bank. 20 minutes
Leave Fri. 5:00pm
generate multiple ways to complete the steps
Drive to the store and park. 10 minutes and, ultimately, the total plan.
Friday

Shop and check out—ask for 30 minutes

a box. Buy wrap and ribbon. Friday
Keep list handy to stay on
track.

Drive home. 10 minutes

Fri. 8:00pm

Wrap gift. 10 minutes

Sat. 3:00 pm

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 Plan–Execute–Repair

Planning Form
“Execute” Phase:
How will I know when I’m finished? Task: Have Bob’s birthday gift ready by Saturday evening.

Many tasks, like this example, have clear

end points: the package is bought, wrapped, Completion
and ready to be presented to Bob. Once all Steps Schedule ✔ Feedback

the steps of the target task have been identi- Balance checkbook. 15 minutes
Need Silence Sunday afternoon ✔
fied, sequenced, worked through, and Decide budget. 3 minutes
checked off, it is easy to determine the stop Sunday afternoon ✔
point. Other target tasks are more nebulous. Schedule time to go to the
mall.
5 minutes
Monday morning ✔
For example, how do you know when you Schedule time to talk to with above
✔
have studied enough or when you have saved friends.

Look in catalogs—check 15 minutes Bob said he has trouble with returns not in
enough money? Quantifying steps and com- delivery times and fees. Monday evening town—don’t use catalogs.

ponents for every task will assist the patient Look online—check delivery
times and fees.
30 minutes
Monday evening ✔
Got off task looking at other items not
related to gift—consider less than 30
in making the determination that it is time Set alarm to limit to 30
minutes.
minutes and use a louder alarm.

to stop.
Talk to friends about ideas. 20 minutes
Wed. afternoon ✔
Schedule time to go to the with third item
bank. Monday morning ✔
“Repair” Phase: Go to the bank. 20 minutes
Leave Fri. 5:00pm
What would I do differently? What would I Drive to the store and park. 10 minutes
do the same? Friday

Shop and check out—ask for 30 minutes

If a plan was successful, ask the patient to a box. Buy wrap and ribbon. Friday
Keep list handy to stay on
analyze why it worked so well. Was it that track.

enough time was allowed? Was it that steps Drive home. 10 minutes
Fri. 8:00pm
were combined in order to make the patient Wrap gift. 10 minutes
more efficient? Encourage the patient to uti- Sat. 3:00 pm

lize positive feedback from others and work

to incorporate that feedback into future
plans. For example, if the birthday card was
especially fitting, return to the store and buy
a few more for future occasions. Conversely,
assist the patient to avoid making the same Helpful Hints: • Even as adults, there is something
mistake twice. Determine what did not go intrinsically satisfying about check-
well and make alterations to the plan for ing an item off a to-do list. It addi-
future use. For example, Bob’s birthday tionally provides an easy visual
occurs at the same time every year. Work summary monitoring completion of
toward not scheduling car maintenance at the task.
this time next year.
• Checklists are great time savers.
Keep these blueprints handy for any
The repair phase needs to be conducted both repeated task. There is no need to
at the end of the task and throughout the reinvent the wheel each time.
activity.

The Source for Executive Function Disorders 164 Copyright © 2003 LinguiSystems, Inc.
 Plan–Execute–Repair

As the patient becomes successful with developing plans, incorporate the develop-
ment of these plans and the review of plans into the daily planning periods of the
daily schedule. Patients should review upcoming or ongoing target projects and their
steps daily, and assign them to available time slots within the day or week. The
patient’s daily to-do list should consist of component steps for many longer term tar-
get projects.

The Source for Executive Function Disorders 165 Copyright © 2003 LinguiSystems, Inc.
 Planning Form

Task:

Completion
Steps Schedule ✔ Feedback

The Source for Executive Function Disorders 166 Copyright © 2003 LinguiSystems, Inc.
 Task Steps Activities

Target: Making the bed with freshly cleaned sheets

Step 1: Check off each item that is critical to the target task.
❏ Wash the sheets.
❏ Strip the bed.
❏ Buy soda at the store.
❏ Call Mary.
❏ Go to the bank.
❏ Buy laundry detergent and fabric softener.
❏ Vacuum the bedroom.
❏ Dry the sheets.
❏ Fluff the pillows.
❏ Find quarters.
❏ Bring the newspaper.
❏ Schedule 1½ hours free.
❏ Collect the dry cleaning.
❏ Drive to the laundromat.
❏ Put the sheets back on the bed.

Step 2: Identify the steps that are omitted from the target task.
✔ Wash the sheets.
✔ Go to the bank.
✔ Buy laundry detergent and fabric softener.
✔ Fluff the pillows.
✔ Find quarters.
✔ Schedule 1½ hours free.
✔ Put the sheets back on the bed.
✔ ________________________________________________________________________

✔ ________________________________________________________________________

✔ ________________________________________________________________________

✔ ________________________________________________________________________

✔ ________________________________________________________________________

✔ ________________________________________________________________________

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 Task Steps Activities

Target: Making the bed with freshly cleaned sheets

Step 3: Write 10 steps you need to take in order to complete the target task.

1. ______________________________________________________________________
______________________________________________________________________

2. ______________________________________________________________________
______________________________________________________________________

3. ______________________________________________________________________
______________________________________________________________________

4. ______________________________________________________________________
______________________________________________________________________

5. ______________________________________________________________________
______________________________________________________________________

6. ______________________________________________________________________
______________________________________________________________________

7. ______________________________________________________________________
______________________________________________________________________

8. ______________________________________________________________________
______________________________________________________________________

9. ______________________________________________________________________
______________________________________________________________________

10. ______________________________________________________________________
______________________________________________________________________

The Source for Executive Function Disorders 168 Copyright © 2003 LinguiSystems, Inc.
 Task Steps Activities

Target: Having the oil in the car changed

Step 1: Check off each item that is critical to the target task.
❏ Clean out the trunk.
❏ Schedule 1 hour free.
❏ Make an appointment.
❏ Replace windshield wiper fluid.
❏ Wash the car.
❏ Drive to the location.
❏ Call Jim.
❏ Have an activity to do while waiting.
❏ Pay car insurance bill.
❏ Pay the bill for the oil change.
❏ Go to the bank.
❏ Drive back home.
❏ Make a notation in the calendar for 3 months later.

Step 2: Identify the steps that are omitted from the target task.
✔ Make an appointment.
✔ Drive to the location.
✔ Have an activity to do while waiting.
✔ Go to the bank.
✔ Make notation in the calendar for 3 months later.
✔ ________________________________________________________________________

✔ ________________________________________________________________________
✔ ________________________________________________________________________

✔ ________________________________________________________________________

✔ ________________________________________________________________________

✔ ________________________________________________________________________

The Source for Executive Function Disorders 169 Copyright © 2003 LinguiSystems, Inc.
 Task Steps Activities

Target: Having the oil in the car changed

Step 3: Write 10 steps you need to take in order to complete the target task.

1. ______________________________________________________________________
______________________________________________________________________

2. ______________________________________________________________________
______________________________________________________________________

3. ______________________________________________________________________
______________________________________________________________________

4. ______________________________________________________________________
______________________________________________________________________

5. ______________________________________________________________________
______________________________________________________________________

6. ______________________________________________________________________
______________________________________________________________________

7. ______________________________________________________________________
______________________________________________________________________

8. ______________________________________________________________________
______________________________________________________________________

9. ______________________________________________________________________
______________________________________________________________________

10. ______________________________________________________________________
______________________________________________________________________

The Source for Executive Function Disorders 170 Copyright © 2003 LinguiSystems, Inc.
 Task Sequencing Activities

Ask the patient to answer these questions in order to practice task sequencing.

What are 15 steps involved in brushing your teeth?

1. Turn on the water.
2. Take out the toothbrush.
3. Take out the toothpaste.
4. Unscrew the toothpaste cap.
5. Apply toothpaste to the brush.
6. Wet the toothbrush.
7. Turn off the water.
8. Brush teeth.
9. Turn on the water.
10. Fill a cup with water.
11. Turn off the water.
12. Rinse.
13. Put away the toothbrush.
14. Screw on the toothpaste cap.
15. Put away the toothpaste.

What are 6 steps involved in making a cup of coffee?

1. Determine the number of cups desired.
2. Fill the coffee pot with the appropriate amount of water.
3. Pour the water into the coffee pot.
4. Put a new filter in the coffee grounds basket.
5. Measure the needed number of scoops of coffee into the basket.
6. Turn on the coffee pot.

What are the steps involved in making a bowl of cereal?

1. Take out a bowl.
2. Take out the cereal and open it.
3. Pour the cereal into the bowl.
4. Put the cereal back in the cupboard.
5. Open the refrigerator.
6. Take out the milk.
7. Pour the milk onto the cereal.
8. Put the milk back in the refrigerator.
9. Get a spoon.

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 Task Combination Activities

Create a schedule to complete each group of tasks within 30 minutes. Combine tasks
when appropriate.

• Make a pot of coffee. (5 minutes)

• Make a bowl of cereal. (2 minutes)
• Read the front section of the newspaper. (10 minutes)
• Shower. (12 minutes)
• Make the bed. (3 minutes)
• Get dressed. (10 minutes)

• Unload the dishwasher. (3 minutes)

• Call a friend. (10 minutes)
• Set the table. (5 minutes)
• Pour drinks. (1 minute)
• Cook a casserole. (25 minutes)

• Listen to the nightly news. (30 minutes)

• Open the mail. (3 minutes)
• Wash the towels. (15 minutes)
• Dry the towels. (15 minutes)
• Stamp letters written earlier. (3 minutes)

• Pay bills. (15 minutes)

• Return phone calls. (10 minutes)
• Sort mail. (3 minutes)
• Sort laundry. (4 minutes)

• Make a grocery list. (3 minutes)

• Decide on a menu. (3 minutes)
• Practice the piano. (15 minutes)
• Water the plants. (5 minutes)
• Make a cup of tea. (5 minutes)

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 Treatment

Memory

R eductions in memory are a common complaint of people with

executive function disorders. Memory is a very complex sys-
tem that relies on a multitude of other brain functions. Memory is
effective only when all the interrelated processes are functioning cor-
rectly.

What patients frequently identify as a memory problem is actually a

result of reductions in levels of attention, poor planning, and/or diffi-
culty initiating activities. For example, a patient may describe failing
to remember anything about a movie he or she saw last week and feel
this is due to a poor memory. In reality, the movie taxed sustained
attention beyond the patient’s ability.

There are an abundance of theories and terms to describe memory, such

as immediate, short-term, long-term, working, sensory, tactile, episodic,
semantic, and verbal. While it is important for the therapist to have an
understanding of these theories and a framework of operation, memory
is a difficult, complex neurological process that needs to be simplified for
the patient.

Step 1 of Improving Memory

Step 1 of improving memory involves the patient learning and believ-
ing four statements:

1. “You can’t remember what you can’t pay attention to.”

The ability to control for deficits in attention is critical to suc-
cessful recall. The patient must actively anticipate and manipu-
late the levels of attention a task requires before the process of
memory can be successful. Review the section on Attention (page

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 Memory

75) with the patient as it relates to specific items he or she is having difficulty
recalling.
• Did the event the patient failed to remember occur after the time limit of
his or her sustained attention?
• Did the event take place in a noisy room or with other competing stimuli?
• Was the patient doing something else at the time the event took place?

For example, the patient reports failing to return a call to the plumber who had
left a message wishing to change appointment times. Upon query, the patient
was listening to the phone messages immediately upon coming in the door. The
patient was tired, hungry, and sorting the mail at the same time he was listen-
ing to the phone message. This is not a failure to remember as much as a fail-
ure in the patient’s divided and selective attention. He could not remember what
he had not paid attention to. Had the patient listened to the phone messages in
isolation with a pen and paper in hand, he would have called the plumber.

2. “You can’t remember what you don’t understand.”

New information is more easily recalled when it fits into an existing schema.
Conversely, information that cannot fit into a present framework is difficult to
process. Understanding the information means not only understanding the
words and the meaning, but also how the information fits into the patient’s life,
organization, and schedule. For example, not attending to or being aware of the
plumber’s appointment in the first place makes a change in schedule difficult to
process and, therefore, difficult to remember.

3. “You must practice your memory at times when the outcome does not
matter — just like you need to practice the piano piece at a time other
than at the recital.”
During clinical sessions and as homework, challenge the patient to work on
recall for the pure aerobic activity of remembering. Outside of formal education,
everyday information tends to be less clearly structured and, therefore, requires
more internal manipulation and clarification to be successfully recalled.
Patients need to “study” memory and practice methods of recall outside the
boundaries of essential tasks.

4. “Memory is an active process: you must consciously manipulate the

information to get it into your head.”
Memory is not a passive process. Information is not stored magically. As
adults, however, the processes of storage and retrieval are so overlearned and
automatic, they often appear involuntary. Patients frequently state, “I didn’t
have to do anything to remember before.” In fact, their brains did plenty, but
patients were not cognizant of the processes working to create a memory.

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 Memory

Step 2 of Improving Memory

The second step of improving memory is to instruct the patient in active methods of
storing and retrieving information. The Memory Techniques handout on page 180
provides several approaches to improving mem-
Helpful Hint: Ultimately, all components of ory skills. The patient needs to be knowledge-
attention and memory must work able of the techniques and should be skilled
cohesively. Manipulate the with each.
patient’s levels of attention within
the clinical memory tasks.

Memory Techniques
➤ Repetition: This includes repeating something over and over in your head.
This can be short term, like repeating a phone number received from informa-
tion just long enough to dial it. If the line is busy when you dial, however, you
will probably forget the number. Repetition can also be used for a longer term.
By reviewing something day after day after day, it will eventually be stored.

Clinical Practice:
• State and describe the 5 Memory Techniques every session.
• State and describe the 5 types of Attention every session.
• Repeat key sayings in every session, such as., “Plan–Execute–Repair” and
“You can’t remember what you don’t pay attention to.”
• Ask the patient to look at the daily schedule at least 3 times per day.
• Ask the patient to look at the daily to-do list at least 3 times per day.
• Ask the patient to look at the target tasks and component steps to particular
tasks every day.

➤ Visualization: See it in your mind. In a perfect form, visualization is photo-

graphic memory. Most of us can’t visualize to that level, but perhaps we can
recall the color of the book or which side of the page the needed material was on.
The same skill can be used to remember if the word is long or short, the graph
up or down, etc. We can also visualize by turning information into visual sto-
ries, much like a mental videotape, then replaying the “video.”

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 Memory

Clinical Practice:
• Provide an assortment of items for the patient to look at for 1 minute. Take
the items away and ask the patient to list the items he or she sees.
Manipulate the following variables:
✔ the length of presentation time
✔ the number of items presented
✔ the similarity of items
✔ the delay between stimuli and recall

• Ask the patient to gaze at a magazine or newspaper page. Note the visual sit-
uation of the page, such as color vs. no color, presence and location of pictures,
and number of headlines. Manipulate these variables:
✔ the length of presentation time
✔ the visual complexity of the page
✔ the delay between stimuli and recall

• Ask the patient to describe or draw a room he or she was previously in, such
as the waiting room. Manipulate these variables:
✔ the forewarning of the activity
✔ the complexity of the situation
✔ the frequency the situation is encountered
✔ the delay between stimuli and recall

• Ask the patient to provide a description of a person he or she encountered,

such as the receptionist. Manipulate these variables:
✔ the forewarning of the activity
✔ the complexity of the situation
✔ the frequency the situation is encountered
✔ the delay between stimuli and recall

• Have the patient read a news story or you read one to the patient. Ask the
patient to create a visual image of the actions and people involved.
Manipulate these variables:
✔ the forewarning of the activity
✔ the complexity of the story
✔ the familiarity of the story
✔ the length of the story
✔ the delay between stimuli and recall

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 Memory

➤ Association: Tie what the patient is to remember into something he or she

already remembers. Build upon previously known facts. Mnemonics are an
excellent association tool. “My Very Educated Mother Just Served Us Nine
Pies” is a mnemonic to remember the planets. (The beginning letter of each
word corresponds to the beginning letter of each planet in the solar system from
Mercury outward). The more bizarre the mnemonic, the more inclined your
patient will be to recall it.
Clinical Practice:
• Provide the patient with functional word lists, such as grocery items. Help
the patient to develop a mnemonic for the list and use this for later recall.
Manipulate these variables:
✔ the number of words to be recalled
✔ the predetermined pattern to the words
banana, apple, lemon, lime = ball
✔ the delay between stimuli and recall
• Read to the patient or have him or her read a news story about an area of partic-
ular interest. Ask the patient to tie the facts into previously known information.

➤ Grouping: Place like items together. Know how many items the patient needs to
remember and how many groups of items exist. It is challenging to remember 21
grocery items, but it’s not difficult to remember 7 meats, 7 vegetables and 7 fruits.
Clinical Practice:
• Provide the patient with a number of items, pictures, or words. Ask the
patient to group them into meaningful categories. Manipulate these vari-
ables:
✔ the number of items
✔ the similarity of the items
✔ the delay between stimuli and recall

➤ Write it down: This is the best method, because if memory fails there is an oppor-
tunity to go back and look. The physical act of writing itself is a memory aid.
Clinical Practice:
• Have the patient write notes from a story he or she read or heard. Take the
notes away and then ask the patient to recall key facts. Manipulate these
variables:
✔ the length of the story
✔ the interest level of the story
✔ the complexity of the story
✔ the familiarity of the story
✔ the delay between stimuli and recall

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 Memory

• Have the patient take notes on a factual Helpful Hint: Always ask the patient how he or she
phone call, such as calling to get infor- was able to remember something to
mation about a movie. reinforce the act of active processing.
Understanding how memory works is
• Have the patient take notes on a con- as equally important as answering
versational phone call with a friend. the questions correctly.
• Have the patient take notes on a seg-
ment from a news program on TV or radio.

Those people with superior memories can use a variety of techniques simulta-
neously. Assist the patient in learning which techniques are best for particular
situations in daily life.

Clinical Memory Tasks

The Memory Tasks on pages 181-183 provide your client with simple word recall
activities. Show the patient a grid of 10 words for 2 minutes. Then cover the target
words and ask the patient to identify them in the midst of 10 additional words. Here’s
an example:

Words to memorize:
COMPUTER HOLIDAY BALLPARK MOTORCYCLE
HAMBURGER TELEVISION NEWSPAPER BIRTHDAY
STADIUM BICYCLE

Circle the words previously seen:

LAUNDRY POLISH BALLPARK BICYCLE
TORNADO COMPUTER CABINET HOLIDAY
NOTEBOOK MOTORCYCLE LAWNMOWER HAMBURGER
FIREPLACE TELEVISION TABLECLOTH OVERCOAT
NEWSPAPER BIRTHDAY STADIUM REFRIGERATOR

Manipulate the difficulty of this task by the following:

• Increase the number of words to be recalled.
• Decrease the time allowed to study.
• Decrease the semantic association of the target words.
• Decrease the visual association of the target words.
• Increase the semantic association of the foil words.
• Increase the visual association of the foil words.
• Ask the patient to recall the target words without cues.
• Decrease the number of words.
• Increase the time allowed to study.
• Increase the semantic association of the target words.

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 Memory

• Increase the visual association of the target words.

• Decrease the semantic association of the foil words.
– Increase the visual association of the foil words.
– Provide the patient with direct cues about which strategy to use and how.

Prospective Memory Tasks

The ability to recall what is to be done in the future is known as Prospective
Memory. Remembering that a dentist appointment is scheduled next month, that
you are supposed to call your accountant next week, or that it is your turn to host
Thanksgiving dinner are all examples of prospective memory.

Within the session, require the patient to perform an act in the future, such as one of
the following:
• Ask what time the next appointment is scheduled at the end of the session.
• Put a magazine in the waiting room when the session is finished.
• Ask to borrow a pen in 5 minutes or turn off the lights in 10 minutes.
• Write a note about a favorite restaurant to be presented next session.
• Walk to the door in 5 minutes.
• Ask for a glass of water before starting the next session.

Conclusion
There are a variety of compensations for reduced memory. Introduce these compen-
sations as they are appropriate to specific tasks with which the patient is involved:
• Establish set locations for personal items, such as keys, wallets, purses, and cell
phones.
• Write a checklist for running errands or doing shopping.
• Use a dictaphone or digital memo recorder to leave yourself messages and notes
quickly and easily.
• Have a pencil and paper handy at all times to make notes to yourself.
• Leave yourself reminder messages on your own voice mail.
• Use a tickler file with a folder for each month and a folder for every day. Put
birthday cards, invitations and follow-up calls
Helpful Hint: Continually check the library and in the folder for the appropriate day and
bookstore for publications on improv- month. Schedule a time to look in these fold-
ing memory and take notes on strate- ers daily.
gies suggested in them. Keep your
own file of helpful memory tricks to
use with patients.

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 Memory Techniques

Repetition: This includes repeating something over and over in your head. It can be
short term, like repeating a phone number you receive from information
just long enough to dial. But if the line is busy, you likely will have for-
gotten the number. Repetition can also be used for a longer term. By
reviewing something day after day after day, it will eventually get into
your head. By looking at and reviewing the steps involved in completing
a task every day, you will remember it.

Visualization: See it in your mind. In a perfect form, visualization is photographic mem-

ory. Most of us can’t visualize to that level, but perhaps we can recall the
color of the book or which side of the page the needed material was on.
You can use this same skill to remember if the word is long or short, the
graph is up or down, etc. We can also visualize by turning information
into stories in our heads, much like a videotape. Then later we can replay
the “video.”

Association: Tie what you want to remember into something you already remember.
Build upon previously known facts. Mnemonics are an excellent associa-
tion task. “My Very Educated Mother Just Served Us Nine Pies” is a
mnemonic to remember the planets. (The beginning letter of each word
corresponds to the beginning letter of each planet in the solar system from
Mercury outward). The more bizarre the mnemonic, the more inclined
you will be to recall it.

Grouping: Place like items together. Know how many things you need to remem-
ber and how many groups of items there are. It’s challenging to
remember 21 grocery items, but it’s not difficult to remember 7 meats,
7 vegetables, and 7 fruits.

Write It Down: This is the best method, because if your memory fails you have an opportu-
nity to go back and look at what you wrote. The physical act of writing itself
is a memory aid.

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 Memory Tasks
Words to memorize:
DOG LION MONKEY BIRD FISH
COW PIG SNAKE CAT HORSE

Circle the words previously seen:

TABLE FISH LEAF WIND DOG
COW SHOES PIG YELLOW HORSE
BASKET LION SNAKE DOOR BIRD
GARAGE MONKEY RADIO CAT PENCIL

Circle the words previously seen:

TIGER DOG COW GOAT RABBIT
PIG LION BEAR SPIDER SQUIRREL
SKUNK MONKEY SNAKE HAMSTER CAT
RACCOON BIRD DONKEY HORSE FISH

Words to memorize:
SEED SUN SIMPLE SUGAR SAID
SOFT SAME SAT SURPRISE SUPPER

Circle the words previously seen:

HANG WEST SAT LIFT SAID
SOFT BLOCK LOST SUPPER SEED
TRUNK SUN SIMPLE JUICE FRUIT
SAME SUGAR BOWL SURPRISE LADDER

Circle the words previously seen:

SUPPER STRAP STOP SEED SHUT
SHOE SOFT SUN SKUNK SPRING
SAME STRAW SUGAR SPADE SURPRISE
STEP SAT SAID SCALE SIMPLE

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 Memory Tasks

Words to memorize:
COMPUTER HOLIDAY BALLPARK MOTORCYCLE HAMBURGER
TELEVISION NEWSPAPER BIRTHDAY STADIUM BICYCLE

Circle the words previously seen:

LAUNDRY POLISH BALLPARK BICYCLE TORNADO
COMPUTER CABINET HOLIDAY NOTEBOOK MOTORCYCLE
LAWNMOWER HAMBURGER FIREPLACE TELEVISION TABLECLOTH
OVERCOAT NEWSPAPER BIRTHDAY STADIUM CUBE

Words to memorize:
JUMP LAUGH SLEEP EAT DRIVE
CLEAN WORK SPEAK WATCH READ
WASH CHANGE BLOW ROLL FIX
MOVE PAY COLLECT FASTEN GIVE

Circle the words previously seen:

WORK BELOW GIVE FIX RECIPE
OTHER FASTEN CUP ROLL COLLECT
KETTLE EGGS BLOW LAKE PAY
BIRD ISLAND CHANGE WATCH MOVE
LIBRARY WASH CLEAN CLOTHES CLASS
JUMP LAUGH WIND SLEEP CITY
EAT SPEAK DRIVE BOOK READ

The Source for Executive Function Disorders 182 Copyright © 2003 LinguiSystems, Inc.
 Memory Tasks

Words to memorize:
ORANGE APPLE BANANA LEMON CHERRY

Circle the words previously seen:

CHAIR TABLE LEMON CHERRY LAMP
ORANGE WINDOW RUG BANANA APPLE

Circle the words previously seen:

BEANS PEAS APPLE ORANGE BROCCOLI
LEMON CUCUMBER BANANA LETTUCE CHERRY

The Source for Executive Function Disorders 183 Copyright © 2003 LinguiSystems, Inc.
 Treatment

Documentation
he purpose of documentation is to objectively chart the

T patient’s performance, enabling modifications, as needed, to

particular treatment tasks and to the overall goals. It addi-
tionally performs a significant role in reimbursement and in providing
credibility to both the field and the therapist personally.

Each treatment task must be clearly defined in terms of its functional

application. This is not only for the purposes of documentation, but
also for allowing the patient a clear understanding of the purpose of
any activity. Stating that the patient achieved a particular accuracy
in crossing out the letter M for 4 lines of small print provides no
insight into why that task was selected. People in everyday life are not
typically required to cross out letters in 4 lines of small print. More
appropriately, this activity would be reported as a selective attention
task requiring paper and pencil activity for 1 minute.

Once the task performed has been established in functional terms, the
patient’s level of performance is stated. Consistent criteria for accept-
able vs. unacceptable responses must be established, and there must
be a predetermined acceptability standard. To accurately judge per-
formance, the criteria must be invariable and apparent to both the
therapist and the patient. Consider the following:
➤ How accurately was each task completed?
➤ How fast/slow were the tasks completed?
➤ How did the speed of performance fluctuate with particular tasks
or as the number of cycles increased?
➤ How many breaks were required?
➤ How easy was it to pick up where the patient left off?
➤ How mentally taxing did the patient find the tasks?
➤ Were compensatory strategies used spontaneously?

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 Documentation

➤ Were errors identified?

➤ Were errors corrected?

It is not sufficient to simply identify that an error occurred. Identifying why that
error occurred is imperative. State what area of deficit caused the patient to fail to
meet the acceptable criteria. Here is an example:
Reductions in sustained attention caused the patient to be unable to attend
to the task for the full 1 minute.
Inability to accurately estimate the time required for the activity caused the
patient to be 2 hours off in scheduling 5 daily activities.

Clearly document what you did to modify the task or enhance the patient’s perform-
ance. State what types of cues you provided, how frequently you provided them, and
what effect the cues had on achievement:
The therapist provided an initial verbal cue.
When provided with written cues throughout the task, the patient’s total
improved to 85%.

The type, frequency, and quantity of the cues you provided to the patient must be estab-
lished in a consistent manner and documented as such. Cues are typically visual,
verbal, tactile, or nonverbal. Additionally, they can be described as follows:
Maximum: The most direct instruction on how to do the task.
The therapist actually shows the patient how to do
the task and walks the patient through each step.
Moderate: The therapist provides cues for greater than 50% of
the task.
Modest: The therapist provides cues for less than 25%-50%
of the task.
Minimal: The least amount of cues provided. Cues may be
entirely nonverbal, such as a pause to give the
patient time to realize an error. An initial cue at
the beginning of the task without further cueing
would be minimal.
Independent: The patient requires no cues from others to com-
plete the task.

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 Documentation

The overall performance of a treatment task can be reported using the same
7-point scale employed by the patient to self-assess:
7 = The task was completed accurately and independently.
6 = The task was completed accurately with minimal cues.
5 = Over half of the task was completed accurately and independently.
4 = Over half of the task was completed accurately, given cues.
3 = Less than half of the task was completed accurately and independently.
2 = Less than half of the activity was completed accurately, given cues.
1 = The task was not completed accurately, even with cues.

Stating the functional implications of each treatment activity, clearly defining the
acceptable level of performance, evaluating each response in a consistent manner,
stating the patient’s strengths and weaknesses with the task, and stating the inter-
ventions you provided will provide strong documentation.

The Source for Executive Function Disorders 187 Copyright © 2003 LinguiSystems, Inc.
 Documentation

Sample Treatment Sessions

(Examples for all treatment areas are modeled in these samples of documentation; however,
all are not typically accomplished in a characteristic 1-hour session.)

#1 Early in Treatment
1. Organizational System (Level 2–3)
➤ Does the patient have the organizational system with her?
➤ What percent of the time has she carried it since last session?
➤ How many appointments/obligations were written into the system this period?
• Did the patient fail to write any in? Why? How did she come to realize this?
➤ Did the patient participate in the Time Estimation Worksheet?
➤ What percent of activities were estimated within 5 minutes? Overestimated?
Underestimated? Discuss.
➤ Specific work on time estimation:
• Patient will estimate within 1 minute how long a newspaper article of
interest will take to read (6-8 paragraphs).
• Patient will estimate within 1 minute how long it will take to travel to the
cafeteria.

2. Attention (Sustained Attention Level)

➤ Restate the 5 types of attention.
➤ Can the patient provide examples of when she used each type in her life?
➤ Did the patient participate in the Activity Worksheet? Discuss.
➤ Did the patient report instances of losing sustained attention to a task?
➤ What percent of today’s situations requiring sustained attention can the
patient identify?
➤ Has the patient identified time limits and breaks for these tasks?
➤ What percent of upcoming situations can the patient identify as taxing sus-
tained attention?
➤ Specific practice with sustained attention:
• Patient will read an article of interest for 2 minutes, take a break, and read
for 2 more minutes.
• Patient will read an article of little interest for 1 minute, take a break, and
read for 1 more minute.
• Patient will visually scan for 1 target letter in medium-sized print for 2
minutes
• Patient will identify 1 target word from an auditory listing for 1 minute.

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 Documentation

3. Memory
➤ Review the 5 techniques to improve memory.
➤ Can the patient provide examples of when each type of memory would be
appropriate in her life?
➤ Did the patient experience any specific memory problems during this period?
Brainstorm.
➤ Anticipate memory challenges in the upcoming week’s events — cues provided.
➤ Specific practice on visualizing:
• Provide 8 related items for 1 minute of visual examination.
• Provide 5 unrelated items for 1 minute of visual examination.
• Play Concentration card game with 16 cards.

4. Plan—Execute—Repair
➤ Using a newly-scheduled event on the patient’s schedule, can she identify one
half of the steps involved in completion of the target task?
➤ With cues, can the patient identify all the steps needed?
➤ With cues, can the patient identify the sequence of the steps?
➤ Specific work on planning:
• Given a simple map, can the patient get from point A to point B?
• Can she develop an alternative plan with constraints imposed, such as “no
highways”?
• Sequence 10 steps in a functional task familiar to the patient.
• Sequence 10 steps in a novel task.

#1 Progress Note
Ms. P brought her organizational system to treatment without a prompt. She
reported inconsistent ability to keep it with her throughout the day, particularly
when running errands, estimating less than 50% compliance. She reported failing
to schedule 1 of 5 appointments this period secondary to not having her system with
her and failing to recall to enter the information later on. She recognized the error
when she received a reminder call the day before the event. She consistently par-
ticipated in the Time Estimation Worksheet, entering over 20 events. Ms. P con-
sistently underestimated the time involved in task completion, on one occasion up
to 1 hour. She readily agreed that this is an area of difficulty for her and she will
continue with the Time Estimation Worksheet during this next period. In specific
drill activity, Ms P was 3 minutes off in her estimation of how long a 6-paragraph
newspaper article of interest would take to read. She had anticipated that she
would be fully accurate in this task. Additionally, she was 2 minutes under in esti-
mating how long it would take to travel to the cafeteria. Again, she anticipated
accuracy with this task.

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 Documentation

When given an initial verbal cue, the patient was able to state and define all 5 lev-
els of attention. She was 50% accurate stating what types of attention were
required for activities from her day. Ms. P reported greater ease in identifying
when her sustained attention was faltering but was unable to independently refo-
cus her attention. She participated in the sustained attention analysis but was
inaccurate estimating how long she could concentrate on a given task in over half
the cases.

On specific drills for sustained attention, she was able to read an article of inter-
est for 2 minutes, break, and then read for 2 more minutes when auditory cues
were provided for the break time. She had anticipated success with this task.
When given an article of little interest to her, she was able to read for 1 minute,
break, and then read for 1 more minute on 1 of 2 attempts when cues for the break
were provided. She anticipated being able to complete more than half this task
accurately and independently. She was able to maintain her visual attention to a
paper and pencil task for 2 minutes but generated 15 errors of omission out of 40.
With an auditory task, she maintained her attention for 2 minutes with 5 errors
out of 40. She had predicted that she would be able to complete both of these tasks
accurately with minimal cues.

The 5 techniques to improve memory were reviewed, with the patient requiring
direct cues from the therapist to provide functional examples of their use. Ms. P
described daily instances during the previous week where she failed to recall
something but was unable to identify why. Direct cues by the therapist assisted
her in this realization. Errors were most often the result of failing to write down
scheduled events and failure to review the schedule. Specific practice with the
compensation of visualization found the patient to recall 6 of 8 similar items pre-
sented visually for 1 minute. She was able to recall 2 of 5 unrelated items.
Initially, the patient clearly lost sustained attention to the task but did not inde-
pendently identify this. After a 1-minute break was offered, she returned to the
task with the previously-mentioned levels of performance. The patient had pre-
dicted that she would complete less than half of this activity accurately, given cues.

When a newly-scheduled event on the patient’s schedule was utilized, she was able
to independently identify less than half the steps involved in completion. When an
array of possible steps was provided, she was able to identify all the steps needed.
Once the steps were established, she was able to successfully sequence the steps.
With specific work on planning, the patient was able to design a route from point
A to point B on a map. She was unable, however, to develop an alternate plan
when the constraint of “no highways” was imposed. It required direct visual and
verbal cues for the patient to see 2 alternate patterns. She had predicted that she
would be able to complete over half of the activity, given cues. When asked to
sequence 10 steps in a functional task familiar to her, she was completely accurate.
When an unfamiliar task was introduced, however, she was able to sequence only
4 of 10 steps. She had predicted that she could complete this accurately with min-
imal cues.

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Sample Treatment Sessions

#2 Mid–Level in Treatment
1. Organizational System (Level 7)
➤ Does the patient have the organizational system with her?
➤ What percent of the time has she carried it since last session?
➤ With what frequency did the patient check her schedule 3 times/day?
➤ Did the patient miss any appointments/obligations? Why?
➤ Were priorities set daily? If not, why? Follow up.
➤ What problems in time management were encountered this last period?
Brainstorm.

2. Attention (Selective Attention Level)

➤ Restate the 5 types of attention.
➤ Can the patient provide examples of when she used each type in her life?
➤ Does the patient report any difficulties with sustained attention this period?
➤ What percent of situations from the last period requiring selective attention
can the patient identify?
➤ How did the patient manage these situations?
➤ Direct practice on selective attention:
• Patient reads 3 paragraphs with quiet music in the background.
• Patient attempts moderate level word retrieval activities in the gym.

3. Memory
➤ Review the 5 techniques to improve memory.
➤ Can the patient provide examples of when each type would be appropriate in
her life?
➤ Did the patient experience any specific memory problems this period?
Brainstorm.
➤ Anticipate memory challenges in the upcoming week’s events (cues provided).
➤ Specific practice on grouping:
• Provide 20 words with 2 obvious groupings.
• Provide 10 words with less obvious groupings.

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4. Plan—Execute—Repair
➤ Review the patient’s currently established plans:
• Did the patient perform all scheduled tasks? Why or why not?
• Did the patient participate in the repair phase with these tasks?
➤ Are there newly-scheduled tasks requiring a plan?
• Did the patient independently instigate attempts to generate a plan?
Provide cues.
➤ Specific work on planning:
• Identify 3 available time options for treatment next week.
• Identify pros and cons of each time option.
• Identify the time frame for homework activities to be completed prior to the
night before.

#2 Progress Note
Ms. P brought her organizational system to treatment without a prompt. She
reported consistent, independent ability to keep it with her throughout the day.
She reported being late for 1 of 4 scheduled appointments this period secondary to
inaccurately anticipating the travel time involved. She consistently identified 1-2
priority activities each day given cues by the therapist. She completed 3 of 5 pri-
ority items — on 2 occasions she failed to check her schedule until after the oppor-
tunity passed. On the other occasion, another task developed that she felt was
more important. The original priority item was independently rescheduled.

The patient was able to independently state and define all 5 levels of attention.
She was 75% accurate stating what types of attention were required for activities
from her day. Ms. P reported easily maintaining her attention to a variety of tasks
for up to 10 minutes, independently utilizing compensatory strategies. In direct
practice of selective attention, she was 80% accurate answering questions about
a 4-paragraph news article of interest that she read while inhibiting a quiet audi-
tory stimuli. She was 60% accurate in moderate-level word retrieval tasks in the
midst of moderate visual and auditory stimuli. She had predicted that she would
be able to complete both of these tasks accurately with minimal cues. Her lower
performance in the word retrieval task was surprising to her as she did not think
the presence of noise and action would distract her from the task.

The 5 techniques to improve memory were reviewed, with the patient requiring
direct cues from the therapist to provide functional examples of their use. Ms. P
described 3 instances during the previous week where she failed to recall some-
thing. For 2 of these instances she independently analyzed the difficulty but
required cues to determine strategies for compensation.

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Specific practice with the compensation of grouping found the patient to recall 15
of 20 random items falling into 2 pre-established categories. She was able to recall
5 of 10 items when no groupings were provided. The patient had predicted that
she would complete less than half of this activity accurately given cues and was
pleased with how many items she was able to recall.

The patient had with her the 2 established plans for executing 2 ongoing activities.
She successfully performed all the scheduled tasks during this period. She had
not, however, analyzed the success or failure of these tasks and required direct
cues to determine what aspects should be modified in the future. The patient iden-
tified 1 additional activity that would require the development of a plan; however,
she had made no attempts to begin this plan. Once cued to do so, she was able to
independently identify 5 steps and their sequence.

In specific work on planning, she required direct cues from the therapist to deter-
mine 3 available time options for the next treatment session. She was unable to
determine possible rearrangements to her schedule when an alternate time was
suggested. The patient had predicted she would complete this activity accurately
and independently. She did not recognize the difficulty she had when her planned
schedule was not accepted and needed alteration.

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 Documentation

Sample Treatment Sessions

#3 Nearing the End of Treatment

1. Organizational System (Level 11)
➤ Does the patient have the organizational system with her?
➤ Does she continue to be consistent in carrying it with her at all times?
➤ Does the patient continue to independently check her schedule 3 times/day?
➤ Did the patient miss any appointments/obligations? Why?
➤ Were priorities set daily? If not, why? Follow up.
➤ Does the patient continue to be consistent in following routines?
➤ Given this week’s schedule, was the patient able to identify situations where
the schedule or plan may not go as anticipated?
➤ In these instances, what percent of the time did the patient identify an alter-
nate plan?
➤ In these instances, what percent of the time did the patient identify more
than 1 alternate plan?
➤ If a change in schedule occurred, was the patient successful in initiating an
alternate plan?
➤ What problems in time management were encountered this last period?
Brainstorm.
➤ Specific practice:
• Given a scenario, identify 5 possible obstacles to the plan.
• Identify 3 possible solutions.

2. Attention (Divided Attention Level)

➤ Restate 5 types of attention.
➤ Can the patient provide examples of when she used each type in her life?
➤ Does the patient report any difficulties with sustained attention this period?
➤ Does the patient report any difficulties with selective attention this week?
➤ What percent of situations from the last period requiring divided attention
can the patient identify?
➤ How did the patient manage these situations?
➤ Direct practice on divided attention:
• Patient reads 3 paragraphs with the weather report in the background,
identifying the low temperature for the day.
• Patient attempts moderate level word retrieval activities in the gym for 3
minutes while keeping track of how many people use the treadmill.
• Patient performs visual scanning of standard print-sized letters, scanning
for s, a, and h for 5 minutes.

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3. Memory
➤ Review the 5 techniques to improve memory.
➤ Can the patient provide examples of when each type would be appropriate in
her life?
➤ Did the patient experience any specific memory problems during this period?
Brainstorm.
➤ Anticipate memory challenges in the upcoming week’s events (cues provided).
➤ Specific practice on associations:
• Provide 10 faces and names for the patient to learn and recall (direct cues
for method of association).
• Provide 5 faces and names for the patient to learn and recall without cues.
• Recall main point and details from the 10-paragraph newspaper article of
interest that she read last session.
• Have patient provide all possible meanings for difficult level homonyms.

4. Plan–Execute–Repair
➤ Review the patient’s currently established plans:
• Are plans in existence for all current tasks?
• Did the patient perform all scheduled tasks? Why or why not?
• Did the patient participate in the repair phase with these tasks?
• What percent of previously-designed plans is the patient reusing?
➤ Did the patient miss any appointments this period?
➤ Was the patient tardy with any deadlines?
➤ Specific work on repair:
• Given a previously-used plan and different constraints/guidelines, what
alterations should she make?

#3 Progress Note
Ms. P brought her organizational system to treatment without a prompt. She
reported consistent, independent ability to keep it with her throughout the day.
She reported consistent timelines with appointments and obligations this period.
She consistently and independently identified 1-2 priority activities each day. She
completed 4 of 5 priority items. The missed item was dropped in favor of another
task that she felt was more important. The original priority item was independ-
ently rescheduled. Ms. P reported consistently following her pre-established rou-
tines. When something interfered with the routine, she reported rescheduling
approximately 90% of the time. Ms. P was able to anticipate 60% of possible inter-
ference with her schedule. With cues from the therapist, this increased to 90%.
She was independent in her ability to generate 1 alternative plan, 70% in devel-
oping 2 alternatives, and 25% in developing 3 alternatives. Ms. P predicted she
would require cues for this but that she would be over half correct.

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 Documentation

The patient was able to independently state and define all 5 levels of attention.
She was accurate stating what types of attention were required for activities from
her day. Ms. P reported easily maintaining her attention to a variety of tasks for
up to 20 minutes, independently utilizing compensatory strategies. She reported
continued difficulty maintaining her concentration in noisy environments but
reported independent ability to utilize compensatory strategies for this.

In direct practice of divided attention, she was 60% accurate answering questions
about a 4-paragraph news article of interest that she read while simultaneously
listening to the radio. She was successful in identifying the target auditory stim-
uli from the radio (low temperature for the day). She was 75% accurate in mod-
erate-level word retrieval tasks in the midst of moderate visual and auditory stim-
uli. Ms. P was simultaneously able to attend to a target visual stimuli (keeping
track of people using the treadmill). She had predicted that she would be able to
complete over half of both of these tasks accurately without cues. She was 85%
accurate in dividing her attention among 3 target items in a visual scanning task.
Again, Ms. P thought she would be able to complete over half of this task accu-
rately without cues.

Ms. P was independent in her ability to state and define 5 techniques to improve
memory and to provide functional examples of their use. Ms. P described 1
instance during the previous week where she failed to recall something. She inde-
pendently identified that she had been distracted by another task at the time the
information was presented to her and did not actively utilize any memory strate-
gies. In reviewing her schedule for the week, she was able to identify at least 1
challenge to memory for each of 5 scheduled activities. She required cues to iden-
tify an additional challenge. At this point, she was independently able to provide
an example of a strategy that would be helpful.

Specific practice with the compensation of association found the patient to recall 7
of 10 random names to match faces when the association method was provided to
her. She was able to recall 3 of 5 names when no direction was provided. The
patient had predicted that she would complete less than half of this activity accu-
rately given cues and was pleased with how many items she was able to recall. Ms.
P was asked to recall the main point from a newspaper article she read 5 days
prior and had been instructed to recall. She recalled 50% of the supporting facts
independently—100% when cues from the therapist were provided. The patient
had predicted that she would be able to do this accurately and without assistance.
Ms. P was able to provide 1 additional meaning for difficult level homonyms 100%
of the time, 2 meanings 75% of the time, and all possible meanings 45% of the time.

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 Documentation

The patient continues to demonstrate success in establishing and carrying out

plans. She independently completed all scheduled tasks this week and did not
miss or was not late for any appointments or deadlines. She has established set
times for routine activities and is independent in their execution. She continues to
have difficulty anticipating possible obstacles to her plans. In specific treatment
tasks, she was able to generate 1 alternative to her plan when a different con-
straint was identified by the therapist. She was, however, unable to independent-
ly identify possible alterations to the plan. She consistently participates in the
Repair Phase of activities and makes written notes on her original plan. She has
not, however, utilized previously-established plans and their repair comments for
recurring tasks, despite opportunity and cues to do so.

The Source for Executive Function Disorders 197 Copyright © 2003 LinguiSystems, Inc.
 Answer Key

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fat, fat, skinny, fat, skinny
skinny, skinny, fat, fat, fat Page 139
skinny, skinny, fat, skinny, skinny 97,92,138,133,93,142,128,101,104,116,83,163,153
fat, skinny, skinny, skinny, fat 5,56,39,22,38,0,40,36,56,18,48,6,74
139,119,98,174,165,157,168,148,130,108,122,179,130
Page 136 72,8,55,11,0,14,5,76,10,38,6,48,24
print, print, cursive, print, cursive, cursive 85,139,88,134,66,129,128,104,172,129,184,166,135
print, cursive, print, cursive, cursive, cursive 50,46,26,50,41,39,47,42,15,11,31,26,37

The Source for Executive Function Disorders 198 Copyright © 2003 LinguiSystems, Inc.
 Answer Key, continued

139,106,150,120,101,135,120,165,194,107,132,109,111 ash tree, remains of something burned

27,19,56,30,64,51,32,18,58,50,17,17,35 average statistic, middle, common
88,140,137,147,93,97,115,76,147,131,100,140,117
2,37,8,34,64,34,9,64,21,33,36,69,26 back position in football, a support, body
172,132,80,139,83,108,116,154,118,116,180,102,127 part, furthest from the front, the side
that is not seen, be behind
Page 140 bail temporarily release from custody,
172,62,80,55,83,22,116,34,118,2,180,48,127 remove water with a container
7,92,8,53,13,142,26,101,4,116,29,161,23 ball pitch not in the strike zone, round
143,56,31,130,42,54,40,148,34,46,52,184,74, toy, formal dance
139,65,98,30,165,13,168,34,130,88,122,17,140
band bind or tie together, stripe of con-
68,178,45,187,0,64,5,102,7,136,6,102,24
trasting color, group of musicians,
85,13,88,18,66,29,125,32,172,69,184,14,135
circular piece of jewelry
55,142,14,108,35,117,53,106,25,115,9,142,37
196,14,150,74,101,43,120,9,164,21,132,37,111 bangs fringe of hair across forehead, loud
33,155,6,166,6764,143,28,156,8,108,37,159,35 noises, vigorous blows, closes violently
88,10,137,50,93,15,95,26,147,19,100,30,117 bank building where money transactions
2,79,8,34,64,90,9,112,21,121,36,117,3 occur, sloping land, a supply held in
reserve for future use, a container for
Page 141 keeping money at home
139,45,351,174,165,595,9,534,21,120,102,68,33
bar counter, act of prevention, a block of
128,154,90,128,46,76,111,22,162,3,69,118,4
solid substance, body of individuals
69,36,198,456,80,48,125,42,163,32,588,14,609
qualified to practice law, rigid piece
36,100,25,54,43,702,348,97,9,9,115,142,498
of wood or metal
96,52,344,62,66,268,204,51,588,30,132,219,101
33,19,6,166,480,51,28,156,8,118,27,149,366 bark sound made by a dog, protective cov-
184,375,7,88,83,15,414,255,49,19,100,116,612 ering of a tree, to speak in unfriendly
28,69,39,118,696,90,29,102,22,450,36,117,3, tones
378,36,66,77,39,329,336,85,7,54,19,248,273 base a support or foundation, place a base
148,162,279,94,76,511,246,96,86,18,92,84,140 runner in baseball must touch before
scoring, military headquarters, low-
Page 146 est part, principal ingredient in a
accident mishap, by chance, car crash mixture
account statement of transactions and result- baste sewing stitch, cooking method
ing balance, formal contractual rela-
bat a turn swinging in baseball, animal,
tionship, narrative record of events,
a club used in hitting a ball, flutter
statement that explains or gives rea-
one’s eyelashes, to strike violently
sons for an action or event
batter a flour mixture, a ballplayer who is
act something people do, legal document,
batting
part of a play, perform an action,
behave in a certain manner, play a beam long piece of material used in con-
role or a part struction, gymnastic apparatus, smile
radiantly
admit allow participation, allow to enter,
means of entrance, acknowledge bear animal, optimistic investor, take on
actions, have room for as one’s own, have rightfully, give
birth, bring forth, to put up with
appreciate increase in value, be fully aware of, to
show gratitude for beat regular rate of repetition, regular
route for a police officer, contraction
arm body part, supply with ammunition
and expansion of the heart, glaring
with intensity, to mix, to be superior,
to win in competition, hit repeatedly,
subject or area covered by a reporter

The Source for Executive Function Disorders 199 Copyright © 2003 LinguiSystems, Inc.
 Answer Key

bed furniture, plot of ground, bottom of bolt sudden abandonment, a type of

ocean screw, roll of cloth, a discharge of
bell hollow device made of metal that lightning, secure with a lock, in a
makes a ringing sound, percussion rigid manner
instrument, button on an outer door, bore hole made by a drill, an uninteresting
grading curve person
belt a band of material to tie or buckle boss a person responsible for employees, to
around waist, endless band of materi- order people around
al between two pulleys, hit vigorous- bow a piece used in playing stringed
ly, sing loudly instruments, a knot used with
bend curved segment of road or river, shoelaces, a decorative ribbon
movement that causes the formation bowl a round dish, to participate in the
of curve, to change direction game of bowling, an important col-
bill rim of a hat that shades the eyes, lege football game
statement of money owed, a statute box to hit, a container, separate area in a
before it becomes law, part of a bird, public place, area on a baseball dia-
to request money mond where the hitter or coach
bit cutting part of a drill, piece of metal stands, rectangular drawing, to par-
held in a horse’s mouth by reins, a ticipate in the sport of boxing
small fragment, unit of measurement brake car part used to slow or stop a vehi-
of information, an instance of some cle, to apply pressure to the pedal in
kind, an indefinite short period of a car or on a bike, stroke of luck
time, a short performance, injured by
teeth or stings brand a name given to a product or service,
identification mark on skin, a symbol
blank explosive charge without a bullet, a of disgrace
substitute for a taboo word, a surface
not written on, a gap or missing part, brick rectangular block of clay, a solid
empty space used to separate words block of material

block a solid piece of material, an inability bridge a card game, structure that allows
to remember or think of something people or vehicles to cross an obstruc-
you normally can do, quantity of tion, upper deck of a ship, the link
related things, rectangular area in a between two lenses, a dental treat-
city, to prohibit something or some- ment, to connect or reduce the dis-
one from moving forward tance between

blow forceful exhalation, powerful stroke brief a condensed written summary, to

with fist or weapon, an unpleasant give essential information to some-
surprise, a strong current of air, one, of short duration, type of under-
burst suddenly, spend wastefully wear

blue color, feeling sad buck male of various animals, one dollar,
move quickly and violently
bluff steep bank, to deceive an opponent in
a card game buckle fastener, to fold or collapse

board flat piece of wood; food or meals; a bug insect, hidden microphone, a fault or
committee having supervisory pow- defect, annoy persistently
ers; a device for controlling other bump an impact, a lump on the body, a type
electrical devices; to get on a train, of dance, reduce in rank, came upon
bus, or airplane by accident
boil a painful sore, to cook in hot water, to cable strong thick rope, television system, a
be in a state of agitation, to change telegram sent abroad
from liquid to vapor

The Source for Executive Function Disorders 200 Copyright © 2003 LinguiSystems, Inc.
 Answer Key, continued

cabinet a storage compartment, an advisory check to inspect something, a maneuver in

body of government chess and ice hockey, a textile pat-
calf baby cow, fine leather, body part tern, the bill in a restaurant, a writ-
ten order for a bank to pay money, a
can metal container, slang for bathroom,
mark indicating something has been
to be able to, expresses permission, to
completed, consign for shipment,
terminate employment
make an investigation, to verify
cap headwear, top of a mushroom, lid,
dental application, an upper limit, chest box with a lid, furniture with draw-
small explosive used in toy guns ers, body part
case portable container, glass container for china a country, high quality porcelain
display, actual state of things, state- chip electrical equipment, used to repre-
ments of fact, a problem requiring sent money in gambling, thin slice of
investigation, an occurrence of some- potato, cow excrement, fragment of
thing, a person requiring services, something broken from the whole,
the outer cover of something, a per- short golf shot
son of a specified kind, to look over
chop karate term, cut of meat, hit sharply
cast object formed by a mold, hard band-
age, a group of actors in a perform- class elegance, the same social or economic
ance, throwing something, to place a status, things sharing a common
vote, to assign roles to actors, formu- attribute, a group of students that
late in a particular style or language are taught together, body of students
who graduate together, a league
center a position in basketball or ice hockey,
ranked by quality
a building dedicated to a particular
activity, cluster of cells governing a clip fastener, to fasten, a short preview
specific bodily process, the object that of a presentation, to cut
interest is focused, the middle club stout stick, playing card symbol,
change to put on a different set of clothes, a group of people, a building, golf
thing that is different, the result of equipment, entertainment spot,
alteration or modification, an event to hit something or someone
that happens when something passes clutch car part, a critical situation, to grasp
from one state or phase to another,
money received in return for its coat the fur covering an animal, article of
equivalent, a group of coins clothing, a thin layer covering some-
thing, to cover the surface of some-
channel a television frequency, a path that
thing
electrical signals pass over, a means
of communication, body of water, to cold absence of heat, a mild infection, loss
direct the flow of of conscious, feeling or showing no
charge to rush toward something, request of affection or friendliness
payment, a person committed to your colon body part, punctuation mark
care, the purchase price charged of company an institution created to conduct
an article or service, an assertion business, a unit of fire fighters,
that someone is guilty of an offense, guests, small military unit, to be
to refresh a battery, to pay with cred-
a companion to someone
it card
charm something believed to be good luck, complex complicated, a psychological disorder
attractiveness, small ornament on a or condition, a group of buildings or
bracelet structures
concentration strengthening by removing extrane-
ous material, spatial property, com-
plete attention, increase in density

The Source for Executive Function Disorders 201 Copyright © 2003 LinguiSystems, Inc.
 Answer Key

contact close interaction, touching physically, deal distributing playing cards, particu-
a person who can give special assis- lars of buying or selling, type of treat-
tance, to communicate with ment received, an agreement
corn vegetable, hard thickening of the skin between parties, large amount
count to list numbers in order, a nobleman, deck platforms on a boat or house, 52 play-
to carry weight, to have faith in, to ing cards, knock down with force,
show consideration for decorate
counter table with horizontal surface, a decline change to something smaller or
return punch, speak in response, lower, go down, get worse, to refuse
indicating opposite, deal with ahead to accept, get smaller
of time dip a quick swim, a brief immersion,
court area where a game is played, resi- sauce to dunk bite-sized foods into, a
dence of a nobleman, an assembly to depression in a level surface, to go
conduct judicial business, engage in down momentarily
social activities direction a general course, a description of how
cover blanket, the act of concealing some- something is done, a line leading to a
thing, be sufficient to meet place or point, managing something
crab a grouch, a crustacean dock landing in a body of water, a platform
for loading and unloading, deduct
crack a brief attempt, an illegal drug, a from wages
sudden sharp noise, a long narrow
opening, witty remark, to fracture down a play in football, soft fine feathers,
eat a lot, not functioning, shut,
crane bird, machinery, to move the neck in understood perfectly
order to see better
creep someone unpleasant, to move slowly,
to grow in a way as to cover page 147
cricket a game, a leaping insect draft a preliminary sketch, a regulator to
control air, a drink, a current of air,
critical calling attention to errors and flaws, a document, compulsory military
verging on a state of crisis or emer- service, to draw up or outline
gency, having the nature of a turning
point, urgently needed draw a poker play, anything taken at ran-
dom, the finish of a contest with no
crop yield from plants, to have hair cut winner, to remove blood, represent
short with a picture
cross an emblem of Christianity, a marking dress clothing, to put clothes on, to bandage
consisting of crossing lines, mixing a wound, provide with clothes, pre-
breeds of animals, to cover a wide pare for market or consumption,
area, meet and pass groom with elaborate care
curb edge between sidewalk and road, drill tool, training in marching and use
limiting excess
of weapons, learning by repetition
dampen make moist, smother or suppress
drop central depository, a sharp decrease
dart a tuck make in sewing, sudden quick in quantity, rapid descent, predeter-
movement, a game piece mined hiding place, a small amount
dash quick run, with great haste, distinc- of liquid, terminate an association,
tive elegance, part of morse code, a stop pursuing, utter casually
race, punctuation mark, destroy, a duck bird, heavy cotton fabric, to move
small amount in cooking quickly, avoiding the issue
date fruit, participant in an outing, an out- dull less lively, boring, not sharp, not
ing, the present, specific day of the
keenly felt, made softer or less loud
year

The Source for Executive Function Disorders 202 Copyright © 2003 LinguiSystems, Inc.
 Answer Key, continued

ear body part, keen hearing, fruiting fit display of temper, sudden flurry of
spike of corn activity, uncontrollable attack, right
egg animal reproductive body, to throw size or shape, insert or adjust, be
eggs at someone or something, to compatible, physically or mentally
goad sound
elder person who is older than you, church flag emblem, stone, signaling device, com-
officer, bush municate or signal, draw attention to
endorse signing checks or documents, guaran- flat deflated tire, shallow seedling box,
tee, give support suite of rooms on one floor, lack of
carbonation, not glossy, having no
engage participate, to be married, start, get depth, lacking enthusiasm
caught
float remains on the surface of liquid, time
eye body part, small hole in needle, good between deposit of check and pay-
discernment, to look at, middle of a ment, ice-cream drink, circulate,
storm move lightly
face confronting bravely, outward appear- flounder fish, behave awkwardly, walk with
ance of something, front of the head, difficulty
status in the eye of others
flush sudden rapid flow of water, poker
fair competitive exhibition, light colored, hand, reddening of the face, sensa-
free of clouds or rain, baseball hit tion of heat, cause to flow
between the foul lines, free of
favoritism, not excessive fly insect, opening in pants, lure, quick
change of emotions, travel by plane,
fall a lapse, movement downwards, sud- to be airborne
den decline, a season, lose power or
office foil thin sheet of metal, picture viewed
with a projector, hinder or prevent
fan device for creating a current of air,
ardent follower, strike out a batter in fool person lacking judgment, indulge in
baseball, agitate the air horseplay, to trick
fast abstaining from food, permanently foot body part, support resembling a
dyed, acting or moving quickly, hur- pedal, unit of length, lowest support
ried and brief of a structure, to pay for something,
to walk
felt fabric, detected by instinct, touch
fork cutlery, branching out, agricultural
file tool for smoothing metal or wood, tool, split in a road
office furniture, set of related records,
register in a public office, to smooth foul violation of the rules of a sport,
disgustingly dirty, obscenity, outside
film thin coating, photographic material, of a boundary
form of entertainment, to record
frame still photographs on a strip of film,
fine money charged as a penalty, texture, human body, supporting structure,
above average, characterized by ele- enclosure for a picture, catch in a
gance, minutely precise, good health, trap
being satisfactory
free no charge, lack of confinement, lack
finish the end, downfall of someone, decora- of obligation, remove obstruction,
tive surface part with
fire shooting weapons, intense criticism, fret agitation caused from worry, erode,
burning event, severe trial, termi- carve a pattern into, metal bar in a
nate, bake in a kiln, provide with fuel musical instrument
firm members of a business, make taut, fudge soft candy, falsify or fake
not likely to fluctuate, not shaky,
unwavering, not soft, secure

The Source for Executive Function Disorders 203 Copyright © 2003 LinguiSystems, Inc.
 Answer Key

game a contest, informal term for occupa- harp musical instrument, lampshade
tion, animal hunted for food or sport supports, nag or repeat in an
gear toothed wheel, equipment for a sport, annoying fashion
to set the level hatch moveable barrier, birth from an egg,
general a fact about the whole, ranking offi- sit on, devise or invent
cer, prevailing among the public, not haze reduced visibility, confusion, initia-
specific tion rituals
glasses eyewear, containers for holding liquid head one side of a coin, body part, top of
grade gradient of a slope or road, degree of something, foam on a drink, person
value, a number or letter of quality, in charge, tip of an abscess, difficult
group of students of the same age juncture, travel towards
grate frame to hold a fire, bars blocking hide body covering of an animal, dressed
passage but admitting air, harsh, skin of an animal, prevent from being
scraping sound, reduce to shreds, seen, to conceal
make resentful hike long walk, increase in cost, salary
graze superficial abrasion, break the skin, increase
eat lightly, feed in a pasture hit big success, striking something, suc-
grease thick fatty oil, lubricate, to apply oil cessful play in sports, dose of a drug,
affect suddenly, come in sudden con-
green color, grass on a golf course, tact, suddenly realize
unhealthy appearance, not ripe,
naive, envious hood engine covering, hat connected to
coat, exhaust vent, young criminal,
grill framework of metal bars, restaurant, slang for neighborhood
cooking method, intense questioning
host animal or plant that supports a para-
groom recently married man, horse stable site, bread used in communion, to
worker, care for appearance, prepar- provide facilities for an event, vast
ing for a future role amount, person responsible for guests
ground connection between an electrical at an event, emcee
device and the earth, a position to be ice frozen water, diamonds, skating rink,
won, motive, top layer of the earth medical treatment
where plants are grown
incline make receptive, tendency to do some-
gum tissue surrounding base of teeth, a thing, elevated geological formation
preparation for chewing, tree, chew
without teeth iron home appliance, golf club, branding
tool, metal shackles, metallic ele-
hail greeting, precipitation, call for, praise ment, to press clothes
ham meat, exaggerate ones actions jack male name, tool, face card, game
hamper container for clothes, restraint that piece, electronic device
restricts freedom, put at a disadvan- jam preserve of crushed fruit, crowd, diffi-
tage cult situation, interfere or prevent
hand physical assistance, body part, signals, bruise, get stuck
pointer on a timepiece, ability, one jar container, sudden impact, affect in a
of two sides to an issue, round of disagreeable way, shock physically
applause, cards held in a card
game, ship’s crew member jerk spasmodic movement, an annoying
person
hard strong, dried out, unfortunate, not
yielding to pressure, difficult, with judge public official, form an opinion, deter-
effort mine the result of competition

The Source for Executive Function Disorders 204 Copyright © 2003 LinguiSystems, Inc.
 Answer Key, continued

key metal device for security, pitch of the like feel about, fond of, find enjoyable,
voice, crucial, a list that explains want to have, wish to do something,
symbols, tonal frame work for music, equal in amounts
vandalize a car limb arm or leg, tree branch, taking a
kid young goat, soft leather, human off- chance
spring, to tease line conforming, cord or rope, railroad
kind type, showing consideration track, commercial organization, kind
knock rapping, negative criticism, bad of product, conceptual separation,
experience, car engine noise mark that is long relative to its
width, text, mark indicating bounds
knot looping and tying, twisted and of the playing area
swollen, navigational unit of meas-
ure, tangle or complicate lip body part, top edge of something
lace delicate fabric, cord to fasten shoes, loaf shaped mass of bread, to be lazy
to draw thru eyes or holes, mix with lock wrestling hold, fastener to secure
alcohol something, cluster of hair
land solid part of the earth, territory occu- lodge hotel, association of people with simi-
pied by a nation, deliver a blow, come lar interests, implant, to provide
to a rest, arrive on shore housing for
lap movement once around a course, log piece of wood, book for keeping track
upper thighs when seated, touching of events, to keep track of events
with the tongue long opposite of short, to miss someone
last the lowest in order, duration, end of lounge a place or room for relaxation, to
life, most unlikely, not to be altered relax, a type of reclining chair
lean rely on for support, to incline or bend, maroon purplish color, to leave stranded, iso-
have a tendency to do, little excess, late without resources
lacking fat
mask concealing activity, a covering to dis-
leaves periods away from military service, guise the face, shield from light
departing politely, remove from par-
ticipation, make possibility for, have mass celebration of the eucharist, having
as a remainder, be survived by, weight, collection of similar things,
refrain from changing, go away from large number, occurring widely
a place match coated piece of wood or cardboard
left opposite of right, have gone, liberal used for starting fires, exact dupli-
political orientation, remainder cate, formal contest, a person of equal
standing, provide funds, bring two
letter written message, award for athletic ideas, people, objects together
or extracurricular participation, sin-
gle character of the alphabet, literal mate officer on a ship, Australian term for
interpretation friend, partner of an animal, chess
move, exact duplicate, fellow member
lie untruth, manner in which something of a team, copulate, partner in
is situated, a place in relation to marriage
something else, to remain in particu-
lar state mean specified degree of importance,
denotes, intend to express, have a
light illumination device, visual effect in purpose in mind, logical consequence,
pictures, public awareness, mental excellent, unkind
understanding, another perspective,
fondly regarded meet athletic contest, collect in one place,
get together socially, satisfy, get to
know, come together, undergo

The Source for Executive Function Disorders 205 Copyright © 2003 LinguiSystems, Inc.
 Answer Key

page 148 page knight’s attendant, errand runner,

might physical strength, express possibility, call out someone’s name, paper in
express permission a book
milk dairy beverage, exploit palm inner hand, tree, touch with the hand
mine explosive device, excavation of the panel sheet that forms a section, pad under
earth, possession a saddle, group of people gathered to
plan or discuss, graphic user inter-
mint plant where money is coined, candy, face, electric device
plant, a lot of something
pants clothing, gasping for air
miss failure to hit, young woman, be
absent, fail to experience, fail to park a recreational green space, to stop a
reach, feel the lack of, leave out car in a particular place, car gear
mold container that liquid is poured into to part less than all, less than whole, line
create a shape, fungus, fit tightly, where hair is divided, portion, acting
shape or influence role, individual efforts, discontinue
an association
mole animal, spot on the skin, spy,
molecular weight pass throwing a ball, aircraft flight, foot-
ball play, free ticket, permit to enter,
mug container with a handle, human face, complete cycle, leave of absence, suc-
to rob, to smile broadly at a camera cess in a test, brief attempt, allow to
nail pointed piece of metal, covering of the go uncensored, go across or through
tip of a finger or toe, attach some- patient person requiring medical care, endur-
thing, locate exactly, succeed, take ing without protest, even tempered
into custody, hit hard
pen writing tool, to write, enclosure for
nap a short sleep, period of time spent animals, jail, female swan
sleeping, fuzzy texture
perch to sit, fish, support that serves as a
negative film with black and white tones resting spot
reversed, denial, number less than
zero, unpleasant, disagreeable period punctuation mark, the end of some-
thing, distinct phase in life, unit of
novel fictional work, pleasantly different, of time
a kind not seen before
permit legal document, formal authorization,
nut small metal block with internal allow the presence of, make possible
screw thread, large hard seed, some-
one devoted to something, eccentric pet domesticated animal, loved one,
person favorite, to stroke
orange color, citrus fruit physical dealing with matter and energy,
having material existence, involving
order document, body of rules, command, the body, using force, complete med-
request for food, arrangement of ele- ical examination
ments, proper arrangement, legal
command, association of people with pick basketball maneuver, heavy tool,
similar interests device to pluck an instrument, a per-
son chosen, best of a group, choosing,
organ wind instrument, body part, govern- gather, provoke, remove in small bits
ment agency
pinch squeeze with fingers, painful circum-
pack small parcel, facial treatment, bun- stances, small amount, make off with
dle, group of animals, association belongings of others
of criminals, to treat a body part,
arrange in a container pit quarry, concealed trap, sizeable
whole, area in front of a stage, inner
layer of fruits, set into rivalry, mark
with a scar

The Source for Executive Function Disorders 206 Copyright © 2003 LinguiSystems, Inc.
 Answer Key, continued

pitch throwing something, card game, golf port an opening, wine, place where people
shot, property of sound, degree of enter or leave a country, computer
deviation from horizontal, up and circuit, left side of a ship or aircraft,
down motion, promotion by demon- land or reach a point
stration, erect and fasten position job, assignment in sports, spatial
pitcher position in baseball, container for liq- property, arrangement of the body, a
uids way of regarding topics, customary
place particular location, slang for house or location, item in sequence, a condi-
apartment, to set something down tion in which you find yourself
plain tract of land, lacking ornamentation, positive characterized by affirmation, number
free from disguise, comprehensible to greater than zero, indicating exis-
the general public, not mixed with tence, optimistic state of mind,
anything impossible to deny
plane tool, aircraft, unbounded two dimen- post delivery and collection of letters, pole
sional shape, level of existence or stake set up to mark something, a
job in an organization, to transfer
plant living organism, building for indus- entries, display, coming after
try, something hidden, an actor in an
audience, put firmly in the mind, put pound unit of measurement, public enclo-
seeds in the ground, lay the ground- sure for stray dogs, hit hard, foreign
work for, set securely unit of money
plate dish, metal sheathing, receptacle for press to push, lift weights, printing
church collection, dental appliance, machine, clamp, printed matter, state
baseball equipment, coat with a layer of urgency, to smooth clothes
of metal prime math term, time of maturity when
play fun activity, preset plan of action power is the greatest, cover with a
in sports, performance by actors, coat of paint, at the best stage
attempt to get something, space for prop support, moveable item on a movie
movement, verbal wit, deliberate set, propeller
coordinated movement, to have an prune dried plum, weed out, to clip
effect on
punch a blow with the fist, tool, beverage,
plot a scheme, story line, chart showing to make a hole
progress, small area of ground
pupil student, eye part
poach cooking technique, hunt illegally
purse bag for carrying money, money
point sharp end, outstanding characteris- offered as a prize, contract lips
tic, geometric element, object of an
activity, brief version, unit of count- quack duck sound, untrained person who
ing the score in sports, linear unit pretends to be a doctor

poker card game, fire iron quality distinguishing attribute, degree of

excellence, a characteristic property,
pole long rod, sports implement, point high social status, superior grade
when the earth’s axis of rotation
intersects with its surface quarter district of a city, U.S. coin, division of
a compass, one fourth, three months,
pool game, excavation filled with water, division of the school year, fifteen
organization of shared resources, minutes, execution method, a period
small body of standing water, of playing time in a sports contest
combination of funds
race contest of speed, competition, division
pop sharp sound, sweet drink, type of of species, to work fast, cause to move
music, informal word for dad, bulge fast
outward

The Source for Executive Function Disorders 207 Copyright © 2003 LinguiSystems, Inc.
 Answer Key

racket illegal enterprise, tennis equipment, ring circular band of jewelry, platform for
loud noise wrestling or boxing, characteristic
range place for shooting or driving, variety sound, association of criminals, circle
of different things, limits of motion, roast piece of meat, negative criticism, cook
open land, series of hills or moun- with dry heat, to be hot
tains, kitchen appliance rock pitch from side to side, mineral mat-
rare low density, uncommon, meat cooked ter, candy, type of music
a short time, not reoccurring often room an area enclosed by walls, space for
rash series of occurrences, red eruption of movement, opportunity for
the skin, disregard for danger, to act rose flower, color
without thinking
round circular, series of professional calls,
rate charge relative to some basis, time ammunition, outburst of applause,
unit, speed of process, be worthy of, cut of beef, serving for everyone, golf
assign a rank to, estimate the value term, approximate to the nearest des-
rattle part of a snake’s tail; baby toy; short, ignated number
loud sounds row continuous succession without inter-
rear side that goes last, farthest from the ruption, objects or people arranged in
back, the hind part of a human or an a line, linear array of numbers, sport,
animal, to raise propel with oars, angry dispute
record list of recognized accomplishments, ruler person who commands, measuring
extreme attainment, compilation of stick
known facts, permanent evidence, run score made in baseball, traveling on
wins vs. losses, sound recording foot at a fast pace, a regular trip, a
reflect cast light, give evidence of quality, short trip, football play, unraveled
bend backward, think deeply stitches, deal in illegally, set animals
refrain part of a song, not to do something, to graze, make without a miss, exe-
cute a program or process
relish experience, savory condiment, get
enjoyment from rung cross piece on a chair, ladder part
report short account of the new, inform ver- runner device on which things can slide, per-
bally, written document, student’s son employed to deliver messages, a
written evaluation, make known to person who travels on foot quickly, hor-
the authorities, make a charge izontal branch of a plant that produces
against new plants, a person who imports or
exports without paying duties
rest freedom from activity, support, musi-
cal notation, death, items left after safe strongbox for valuables, free from
other parts have been taken away danger, in good hands, financially
sound
rich of great worth, pleasantly full and
mellow, containing large amounts of sage herb, wise mentor, color
choice ingredients, abundant supply saw tool, to cut, to have seen
of desirable qualities or substances, scale body part of fish, indicator, measur-
possessing material wealth ing instrument, relative magnitude,
right principles of justice, direction, conser- ratio between size and representa-
vative political orientation, make tion, ordered reference standard, to
amends for, regain proper position, remove, reach the highest point, to
make correct, appropriate for the cut back
condition, free from error, socially school group of fish, building of education,
correct, immediately, interjection being formally educated, train to be
expressing agreement discriminating

The Source for Executive Function Disorders 208 Copyright © 2003 LinguiSystems, Inc.
 Answer Key, continued

seal marine animal, impression device, shot attempt, immunization, attempt to

fastener, a finishing coat, approved score in a game, bullet from a gun,
superior status, make tight track equipment, hard blow to the
season period of the year, recurrent holiday body
time, lend flavor to, make fit sight optical instrument, range of vision,
second unit of time, following first, baseball ability to see, visual perception
term, to agree with a motion, imper- sign indication, written message, gesture
fect merchandise, gear in a car to communicate, evidence, parts of
select to choose, superior grade the Zodiac, written agreement, to
write your name
sentence string of words, prison time, final
judgement sink plumbing fixture, descend into, golf
term, go under
set exercises done in a series, putting
something in position, electronic slide gliding, transparency, rectangular
equipment, decent of the sun, a group plate, sloping chute, large mass of
of things, abstract collections of num- earth falling, baseball maneuver
bers, unit of play in tennis, scenery in slip undergarment, to avoid capture,
a production, permanent inclination, minor mistake, small piece of paper,
becoming hard, establish a record, accidental misstep, slender person,
ready to start a race unexpected slide, part of a plant, get
shake grasp a person’s hand, building worse, boat dock
material, reflex caused by cold, frothy slug insect, to hit hard, an idle person
ice-cream drink, undermine, get rid snap putting a football in play, fastener,
of, stir the feelings of easy activity, break suddenly, angry
share assets contributed, stock, individual tone, sound made with fingers, record
efforts in a common goal, use jointly, on film, grab hastily
communicate soil to get dirty, dirt
sharp musical note, pointed, keenly felt, sole fish, bottom of shoe or foot
quick and forceful, in great amount,
harsh, bitter in taste solution mixture, answer to a problem

shed an outbuilding, cast off hair, get rid sound auditory effect, ocean inlet, cause to
of, pour out in drops make noise, appear interesting,
financially safe, excellent condition,
sheet bed linen, piece of paper, flat thin morally correct, deeply, showing good
material, to rain hard judgment
shock unpleasant surprise, bushy mass, space expanse where everything is located,
grain set on ends to dry, bodily col- blank area, spot in line
lapse, car part, feeling of distress,
passage of electronic current spade tool, suit in cards
spare bowling term, an extra item, not
needed, refrain from harming, relieve
Page 149 from experiencing, use frugally
shop place of business, to browse, speaker someone who addresses a group, pre-
to compare siding officer, amplification device
short baseball term, electrical circuit prob- spell verbal formula, period of time, indi-
lem, cheat someone, low in stature, cates, write or name the letters that
most direct, having little length, form a word
speech sounds, direct
spoke wire support within a wheel, to have
talked

The Source for Executive Function Disorders 209 Copyright © 2003 LinguiSystems, Inc.
 Answer Key

spot entertainment establishment, con- stock merchandise in a shop, lumber, capi-

trasting part of something, section tal raised by a corporation, descen-
assigned to a performer, small quan- dants of an individual, supply for
tity, blemish, catch sight of future use
spring spiral device, natural flow of water, strain exertion, injury to muscle, nervous-
season, elasticity of something, dis- ness from stress, group of organisms,
close suddenly, move forward quickly force to the limit
square tool, shape, old-fashioned, product of strand piece of complex fibers, necklace,
two equal terms, honesty, firmly, in a abandon
direct way straw thin plastic tube, plant fiber, yellow
squash a game, vegetable, compress color
stable farm building, dependable, maintain- strike baseball pitch, bowling term, an
ing equilibrium, showing little attack, refusal to work, gentle blow,
change remove by erasing
staff strong rod, system that musical notes strip to undress, narrow flat piece of mate-
are written on, group of employees rial, sequence of cartoon drawings, an
stage section or portion, large platform, the airfield, to remove a covering from
theatre as a profession, large coach stroke light touch of the hand, single com-
with horses, time period, plan an plete movement, to hit a golf ball, a
event mark made by writing, sudden loss of
stalk threatening gait, hunt for game, slen- consciousness, treat gingerly
der structure, harass stump part of a limb or tooth, base of a tree,
stall to put off, place within a barn for cause to be perplexed
livestock, a stopped engine sty pigpen, infection of the eye
stamp a block used to imprint, token for submarine submersible warship, sandwich
paid postal fees, distinctive form, suspect someone under suspicion, to believe a
extinguish person is guilty, imagine to be true,
stand to be in an upright position, to be in a regard as untrustworthy
specified state, a booth with items for swallow bird, small amount of food or liquid,
sale, defensive effort believe without questioning, to ingest
staple paper fastener, necessary item, to food or drink
fasten switch changing for another, basketball
star celestial body, a graphic design, an maneuver, instrument of punish-
outstanding or famous person ment, control device, railroad track
state the way something is, organized body device, one thing substituted for
of people, territory, express an idea another, reverse
stay remaining in a place, nautical brace, tag a children’s game, touching someone,
thin strip used to stiffen a garment, a label, baseball term, provide with a
judicial order nickname
steer bull, direct the course, guiding force tail animal part, rear of an aircraft, a
spy, last part of something, follow
stick length of wood, pierce or puncture, closely behind
cause to protrude, stay put, piece of
hockey equipment, piece of gum tank container, military vehicle, prison cell
still apparatus for making alcohol, static tap light touch, cutting tool, dancing
photograph, tranquil silence, cause to shoe, faucet, draw from, furnish with
be quiet, free from current, absence of a spigot
sound

The Source for Executive Function Disorders 210 Copyright © 2003 LinguiSystems, Inc.
 Answer Key, continued

tape long strip used for fastening, musical tune succession of notes, to adjust
recording, line strung across the fin- turkey bird, an event that fails badly, annoy-
ishing point in a race ing or unpleasant person, three
temple place of worship, side of forehead strikes in a row in bowling
tense category of verbs, stretch tightly, turn moving in the opposite direction,
uncomfortable agreed succession, a favor, unfore-
tick parasite, light mattress, tapping seen development, become older,
sound assume new characteristics, direct at
someone, alter the function, pass into
tie cord of material, horizontal beam, a condition, to let go
cross braces on a railroad track,
equal score, neckwear, social or type printed characters, a particular kind
business relationship, to knot of thing, write with a keyboard
tip potential opportunity, extreme end, uniform clothes with distinctive design for
small amount of money for services, identification, evenly spaced, the
cause to tilt, to walk on your toes same
tire hoop that covers a wheel, exhaust utter express audibly, extreme
through overuse, cause to be bored vault arched ceiling or roof, burial cham-
toast bread that has been browned, kind ber, compartment for safekeeping
words before a drink, make brown valuables, leap over, gymnastic
and crisp equipment
toll fee levied, value measured, ring vice moral weakness, division in police
recurrently department
top clothing, covering for a hole, toy, wake a vigil, wave behind a boat, conse-
greatest possible intensity, upper- quences of an event, be alert, stop
most of anything, first half of an sleeping
inning, canvas tent, to go beyond watch to guard, portable timepiece, follow
or better with eyes or mind, look attentively,
toy nonfunctional replica, breed of small to be on guard
dog, plaything, manipulate wave movement of water, hairdo, signaling
track sport, bars of rolled steel, evidence with the hand, progressive distur-
pointing to a solution, selection of bance
music, racecourse, carry on the feet well a hole dug to obtain water, enclosed
and deposit, to go after compartment, come up, good health,
trail path, mark left by something, evi- high probability, satisfactory, suit-
dence pointing to a solution, proceed ably, financial comfort, extent or
slowly, linger behind, to go after degree, intimate knowledge
train public transportation, cloth on the whip quick snap, instrument for hitting,
back of a gown, a procession, force thrash about, defeat thoroughly
to grow in a certain way, undergo will persistent intent, legal document,
instruction, exercise to prepare for decree or ordain
an event yard enclosure for animals, land around a
truck vehicle, hand cart, to transport, to house, area for storage of cars, unit of
move quickly length
trunk luggage, main stem of a tree,
elephant’s nose, torso, compartment
in a car
tumbler glassware, part of a lock, gymnast
19-04-98765432

The Source for Executive Function Disorders 211 Copyright © 2003 LinguiSystems, Inc.