Relationships Between Executive Functions and Language Variables

1
Relationships Between Executive Functions and
Language Variables

• Suzanne Hungerford, Ph.D., CCC-SLP
• Katherine Gonyo, M.C.D., CCC-SLP

2
Language processing is more than a linguistic
task

• Information processing models of language
  impairment take into account
• Linguistic factors
• Perceptual factors
• Cognitive factors (processing speed, attention,
  working memory, executive functions)
• (Gomes, Wolfson, Lalperin, 2007 Leonard, et
  al., 2007 Montgomery, 2002 Montgomery
  Windsor, 2007 Snyder, Dabasinskas OConner,
  2002).

3
Executive Dysfunction

• Executive functions, in particular, are cognitive
  functions thought to influence language
  performance.
• Executive functions (or executive skills) allow
  us to organize our behavior over time and
  override immediate demands in favor of
  longer-term goals.
• (Dawson and Guare, 2004, p.1).

4
Executive functions include

• Follow through, sustained attention, performance
  monitoring, inhibition of impulses, goal-directed
  behavior, and working memory.
• (Dawson Guare, 2004)

5
Working memory

• Phonological working memory, in particular, is
  hypothesized to be a significant contributor to
  on-line language processing, reading
  comprehension, and some types of language
  formulation.
• (Archibald Gathercole, 2006 Baddely, 1986
  Baddeley,Gathercole, Alloway, Willis, Adams,
  2006 Leonard, et al., 2007 Montgomery, 2002
  Westby Watson, 2004)

6
Research purposes

• To examine a number of executive functions, and
  determine if executive functions (as measured by
  the BRIEF) are related to language performance
  (on the CELF-4) in referred children.
• Which executive functions are most predictive of
  language test performance?
• Are teacher or parent executive dysfunction
  ratings most predictive of language performance
  in children?
• Which executive functions are most predictive of
  language performance?
• Which measures of language functioning can be
  best predicted by executive functioning.

7
Subjects

• N 17
• 11 male
• 6 female
• average 115.76 months (about 9 ½ years) of age
• minimum 91 mo
• maximum 162 mo.

8
Subjects

• Referred for Auditory and Language Processing
  assessment.
• All experience learning difficulties such as
  trouble listening in the classroom, academic
  failure, reading disability, difficulty following
  directions, language disorder.

9
Methods

• Behavior Rating Inventory of Executive Functions
  (BRIEF Gioia, Isquith, Guy, Kenworthy, 2000)
• parent form
• teacher form
• Composite scores from the Clinical Evaluation of
  Language Fundamentals (CELF-4 Semel, Wiig,
  Secord, 2003)
• Working Memory
• Core Language
• Receptive Language
• Expressive Language
• Language Content

10
Methods

• BRIEF completed by
• parents and
• classroom teacher of each child
• CELF-4 administered by supervised graduate
  student as part of interdisciplinary assessment.

11
Methods

• T-scores from the BRIEF
• Behavior Regulation Index (Composite)
• inhibiting impulses
• shifting attention
• maintaining emotional control
• Metacognitive Index (Composite)
• initiating actions
• working memory
• planning/organization
• organization of materials
• self monitoring
• Global Executive Composite

12
Methods

• CELF-4 composites
• Working Memory
• Core Language
• Receptive Language
• Expressive Language
• Language Content

13
Statistics

• SPSS for Windows 10.0
• Alpha level set at .05
• Analyses used Stepwise Linear Regressions

14
Results of first analysis

• Independent (predictor) variables
• BRIEF composite scores from Parent and Teacher
  forms
• Dependent
• CELF-4 composite scores

15
Results

• Teacher BRIEF Metacognitive Index scores
  predicted CELF-4 Working Memory (R2 .340,
  R2adj .280, F (1,11)5.67, p.036), and CELF-4
  Receptive Language Scores (R2 .318, R2adj
  .266, F(1,13)6.07, p.029).

16
Results

• Teacher BRIEF Global Executive scores predicted
  CELF-4 Core Language composite scores (R2 .356,
  R2adj .310, F(1,14)7.74, p.015)

17

• No BRIEF composite scores predicted Language
  Content or Expressive Language

18

• Parent BRIEF composite scores had no predictive
  value.

19
BRIEF COMPOSITE SCORES
Teacher Metacognitive Index and Global Executive
Functioning were predictive of language scores
(elevated T-scores).
20
CELF-4 composite scores depressed
21
Results of 2nd analysis

• Subcomponents of Metacognitive Index were used to
  determine if specific variables existed that had
  predictive values for language
• Initiate
• Working Memory
• Planning/Organization
• Organization of Materials
• Monitor

22
Teacher BRIEF Metacognitive Subscales
These T-Scores show that almost all the
metacognitive subscale scores were at least one
standard deviation from the mean.
23
Results

• BRIEF Planning/Organization predicted CELF-4
  Working Memory scores (R2 .537, R2adj .491, F
  (1,10) 11.67, p 007).
• BRIEF Working Memory predicted CELF-4 Receptive
  Language scores (R2 .350, R2adj .300,
  F(1,13)7.00, p .020),
• BRIEF Initiate predicted CELF-4 Language Content
  (R2 .474, R2adj .403, F(1,12) 10.79,
  p.007).
• No metacognitive predictors of Core Language or
  Expressive Language

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25
Summary/Conclusions

• Only teacher ratings of executive function
  predicted language, parent ratings did not.
• Of the teacher BRIEF ratings, Metacognitive
  composite scores and Global Executive Composite
  Scores, but not Behavior Regulation composite
  scores, had predictive value for language.

26
Summary/Conclusions

• Three Metacognitive subscale scores were strongly
  related to language.
• BRIEF Working Memory scores were predictive of
  Receptive Language, as the literature might
  predict, but other executive functions (Initiate,
  Plan/Organize) were also significant predictors
  of language performance.
• All CELF-4 variables studied except Expressive
  Language had executive function predictors
  either composite scores or metacognitive subscale
  scores.

27
Summary/Conclusions

• Core Language and Expressive Language had no
  Metacognitive subscale predictors perhaps
  because these measure largely sentence-level
  processing which may not tax higher level
  executive functions such as attention and working
  memory.
• Language is not uniformly related to executive
  functions, as some, but not all, CELF-4
  composites had executive function predictors.

28
Summary/Conclusions

• Children with language and learning disorders
  must be evaluated for executive dysfunction, as
  it is strongly related to language and learning
  difficulties.

29
Summary/Conclusions

• Future studies should be done to determine if
  improving executive functioning (either through
  behavioral therapy or medication) also improves
  language performance.
• There is some recent evidence that
  methylphenidate does improve language processing
  in children with ADHD (McInnes, et al., 2007).
• See handout, Appendix A, for more information
  regarding pharmacological and behavioral
  intervention for executive functions
  (particularly working memory.)

30
References

• Archibald, L. M. D. Gathercole, S. E. (2006).
  Short-term and working memory in specific
  language impairment. International Journal of
  Language Communication Disorders, 41(6),
  675-693.
• Baddeley, A. D. (1986). Working Memory. Oxford
  Oxford University Press.
• Baron, I. S. (2000). Test review Behavior
  Rating Inventory of Executive Function. Child
  Neuropsychology, 6(3), 235-238.
• Dawson, P. Guare, R. (2004). Executive skills
  in children and adolescents A practical guide
  to assessment and intervention. New York, NY
  The Guilford Press.
• Gioia, G.A., Isquith, P. K., Guy, S.C.,
  Kenworthy, L. (2000). Behavior Rating Inventory
  of Executive Functions. Odessa, FL Psychological
  Assessment Resources.
• Gomes, H. Wolfson, V., Halperin, J. M. (2007).
  Is there a selective relationship between
  language functioning and auditory attention in
  children? Journal of Clinical and Experimental
  Neuropsychology, 29(6), 660-668.
• Leonard, L. B., Weismer, S. E., Miller, C. A.,
  Francis, D. J., Tomblin, J. B., Kail, R. V.
  (2007). Journal of Speech. Language, Hearing
  Research, 50, 408-428.

31
References

• McInnes, A., Bedard, A., Hogg-Johnson, S.,
  Tannock, R. (2007). Preliminary evidence of
  beneficial effects of methylphenidate on
  listening comprehension in children with
  Attention-Deficit/Hyperactivity Disorder.
  Journal of Child and Adolescent
  Psychopharmacology, 17(1), 35-49.
• Montgomery, J. W., Windsor, J. (2007).
  Examining the language performances of children
  with and without specific language impairment
  Contributions of phonological short-term memory
  and speed of processing. Journal of Speech,
  Language, and Hearing Research, 50, 778-797.
• Montgomery, J. W. (2002). Information processing
  and language comprehension in children with
  specific language impairment. Topics in Language
  Disorders, 22(3), 62-84.
• Semel, E., Wiig, E. H., Secord, W. A. (2003).
  Clinical Evaluation of Language Fundamentals 4
  (CELF-4). San Antonio The Psychological
  Corporation.
• Snyder, L., Dabasinskas, C., OConnor, E.
  (2002). An information processing perspective on
  language impairment in children Looking at both
  sides of the coin. Topics in Language Disorders,
  22(3), 1-14.
• Westby, C. Watson, S. (2004). Perspectives on
  attention deficit hyperactivity disorders
  Executive functions, working memory, and language
  disabilities. Seminars in Speech and Language,
  25(3), 241-254.

32
Suggested Readings and Websites

• Adams, A. M., Gathercole, S.E. (2000).
  Limitations in working memory implications for
  language development, International Journal of
  Language and Communication Disorders, 35(1),
  95116.
• Baddeley, A. D. (2003). Working memory and
  language An overview, Journal of Communication
  Disorders, 36, 189208.
• Baddeley, A. D. Hitch, G. (1974). Working
  memory. In G.A. Bower, Editor, Recent advances
  in the psychology of learning and motivation Vol.
  8, New York Academic Press.
• Baddeley, A., Wilson, B. A. (1993). A
  developmental deficit in short-term phonological
  memory implications for language and reading.
  Memory. Mar1(1)65-78.
• Faraone, S.B., Wigal, S. B., and Hodgkins, P.
  (2007). Forecasting three-month outcomes in a
  laboratory school comparison of mixed amphetamine
  salts extended release (Adderall XR) and
  atomoxetine (Strattera) in school-aged children
  with attention-deficit/hyperactivity disorder.
  Journal of Attention Disorders, 11,74-82.
• Klingberg, T., Fernell, E., Olesen, P., Johnson,
  M., Gustafsson, P., Dahlstrom, K, Gillberg, C.
  G., Forssberg, H., Westerberg, H. (2005). J.
  Am. Acad. Child Adolesc. Psychiatry, 44(2),
  177-186.
• Olesen, P. J., Westerberg, H., Klingberg, T.
  (2004). Increased prefrontal and parietal
  activity after training of working memory.
  Nature Neuroscience, 7(1), 75-79.
• van Daal, J. Verhoeven, L., van Leeuwe, J., van
  Balkom, H. (2007). Working memory limitations in
  children with severe language impairment. Journal
  of Communication Disorders. Doi10.1016/j.jcomdis.
  2007.03.010.

33

• Heres a website that answers many questions on
  working memory
• http//www.aboutkidshealth.ca/ofhc/news/SREFarchiv
  e.asp http//psychology.dur.ac.uk/research/wm/FAQ
  WM.htm
• This is an article in the British Journal of
  Developmental Psychology (2005) on working memory
  and its relation to classroom learning in
  preschoolers
• http//www.york.ac.uk/res/wml/Alloway20BJDP.pdf
• The Working Memory Test Battery for Children
• http//www.innovact.co.za/Working20Memory20Test
  20Battery20for20Children20(WMTB-C).htm
• Childrens Test of Nonword Repetition A Test of
  Phonological Working Memory
• http//www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd
  RetrievedbPubMedlist_uids7584287doptAbstract
  
• Article includes a section on training working
  memory
• http//www.aboutkidshealth.ca/ofhc/news/SREF/4898.
  asp

34

• The BRIEF (Behavior Rating Inventory of Executive
  Function) has teachers and parents rating
  scales of executive function (which includes
  working memory). It is norm-referenced, and can
  be found here
• http//www3.parinc.com/products/product.aspx?Produ
  ctidBRIEF
• Working Memory, Language and Reading by Maxine
  Young
• http//www.brainconnection.com/topics/?mainfa/mem
  ory-language
• The Neurological Scratchpad Looking at Working
  Memory by Kumar Narayanan
• http//www.brainconnection.com/topics/?mainfa/wor
  king-memory

35
Appendix AClinical Recommendations in the
Literature Regarding Working Memory and Language

• Westby, C. Watson, S. (2004). Perspectives on
  attention deficit hyperactivity disorder
  Executive functions, working memory, and language
  disabilities. Seminars in Speech and Language,
  25(3), 241-254.
• Westby (2004) states Particularly on more
  complex language tasks, a students poor
  performance may be primarily due to WM deficits
  rather than linguistic deficits. (She recommends
  testing both language and working memory in
  assessment.)

36

• Montgomery, J. (1996). Sentence comprehension
  and working memory in children with specific
  language impairment. Topics in Language
  Disorders, 17(1) 19-32.
• ideas involve reducing the processing load when
  teaching a child new linguistic material. For
  example, he states .interventionists should
  analyze the demands placed on working memory by a
  specific task and attempt to reduce processing
  loads when first introducing new language forms.
• Furthermore, he states clinicians can
  mitigate capacity limitations in children with
  SLI by working to increase automaticity of newly
  acquired language skills. As more aspects of
  linguistic processing become automatic, fewer
  resources are used so that the net effect is
  increased capacity. Automaticity is accomplished
  through practice..clinicians can promote
  automaticity by providing repeated opportunities
  for meaningful use of particular language forms
  and functions and by firmly establishing language
  skills before advancing to new goals.

37

• Gillam, R. B. van Kleeck, Anne (1996).
  Phonological awareness training and short-term
  working memory Clinical Implications. Topics
  in Language Disorders, 17(1) 72-81.
• In this article, Gillam and van Kleeck state that
  they believe that if clinicians target
  phonological awareness in therapy with young
  children, both early literacy development and
  phonological working memory may improve.

38

• Montgomery, J. W. (2002). Understanding the
  language difficulties of children with specific
  language impairments Does verbal working memory
  matter? American Journal of Speech-Language
  Pathology, 11, 77-91.
• In terms of intervention, again he suggests the
  usefulness of early intervention of phonological
  processing as a preventive intervention. For
  older students other ideas include the use of
  verbal rehearsal strategies, chunking memory
  strategies, paraphrasing may help to condense a
  large volume of language material into smaller,
  well-integrated units. By having him/her restate
  and rephrase the material, the students
  comprehension, integration, and retention of the
  material should be improved by maximizing the
  dual operations of storage and processing
  (Montgomery, 2002, p. 89).

39

• T. P. Alloway (2006). How does working memory
  work in the classroom? Educational Research and
  Review, 1(4), 134-139.
• This article reviews the role of WM in reading,
  mathematics, and learning in general. In terms
  of remediation the author writes
• We CAN change childrens ability to learn by
  reducing working memory demands in the
  classroom (p. 137). Here are some ideas the
  author offers in this regard. Reduce processing
  demand by
• Using common vocabulary in sentence generation
  tasks to reduce memory load
• Improve sentence processing by using simple
  sentences
• Use of external memory aids (visuals) that can
  help a child remember the steps in a task (but
  children need practice in using these external
  reminders)
• Encourage kids to continue complex tasks instead
  of giving up (cont.)

40

• Foster comprehension monitoring strategies
  that is, train kids to recognize when they are
  having trouble remembering, and to ask for help,
  or take other actions to complete a task
• Provide instructions that are as brief and as
  simple as possible
• Break instructions and tasks into the smallest
  possible steps
• Frequent repetition of instructions
• For tasks that take place over an extended
  period of time, reminding the child of crucial
  information for that particular phase of the task
  rather than repetition of the original
  instruction ( p. 138)
• Ask the child to repeat information given to
  them.

41

• There is some evidence that intensive training
  can improve working memory and change prefrontal
  and parietal activity in the brain. See
• Klingberg, T., Forssberg, H., Westerberg, H.
  (2002). Training of working memory in children
  with ADHD. Journal of Clinical Experimental
  Neuropsychology, 24, 781-791.)
• Klingberg, T., Fernell, E., Olesen, P., Johnson,
  M., Gustafsson, P., Dahlstrom, K., Gillberg, C.
  G., Forssberg, H., Westerberg, H. (2005).
  Computerized training of working memory in
  children with ADHD-A randomized, controlled
  trial. Journal of the American Academy of Child
  and Adolescent Psychiatry, 44(2), 177-186.
• These researchers used a computer-based training
  program, Cogmed Cognitive Medical Systems, which
  is now available commercially
  http//cogmed.com/cogmed/
• Olesen P, Westerberg H, Klingberg T (2004).
  Increased prefrontal and parietal brain activity
  after training of working memory. Nature
  Neuroscience 775-79

42

• McInnes, A., Bedard, A., Hogg-Johnson, S.,
  Tannock, R. (2007). Preliminary evidence of
  beneficial effects of methylphenidate on
  listening comprehension in children with
  Attention-Deficit/Hyperactivity Disorder.
  Journal of Child and Adolescent
  Psychopharmacology, 17(1), 35-49).
• In a recent placebo-controlled, double-blind
  study with children with ADHD, methylphenidate
  (Ritalin) was found to improve higher-level
  language functioning (making inferences about
  spoken passages), but not basic language
  processing (remembering facts from spoken
  passages and understanding isolated sentences ).
  They also found the drug improved visual-spatial
  working memory, but not verbal working memory.

43

• Coghill, D.R., Rhodes, S. M., Matthews, K.
  (2007) The neuropsychological effects of chronic
  methylphenidate on drug-naïve boys with
  attention-deficit/hyperactivity disorder,
  Biological Psychiatry, 62, 954-962.
• In a placebo-controlled, double-blind study,
  found virtually no effect of methylphenidate on
  executive functioning in neuropsychological
  testing.

44

• Swanson, J. M., Wigal, S. B., Wigal, T.,
  Sonuga-Barke, E., Greenhill, L. L., Biederman,
  J., Kollins, S., Nguyen, A. S., DeCory, H. H.,
  Dirksen, S. J. H., Hatch, S. J, and the COMACS
  Study Group (2004). Pediatrics, 113(3),
  e206-e216. Retrieved November 9, 2007, from
  http//www.pediatrics.org/cgi/content/full/113/3/e
  206
• Found methylphenidate improved attention,
  deportment, and an academic-related measure in
  children with ADHD.

45

• Faraone, Wigal, Hodgkins (2007). Forecasting
  three-month outcomes in a laboratory school
  comparison of mixed amphetamine salts extended
  release (Adderall XR) and atomoxetine (Strattera)
  in school-aged children With ADHD . Journal of
  Attention Disorders, 11(1), 74-82.
• These researchers found Adderall to be more
  effective than Strattera in improving attention,
  deportment (behavior), and academic performance
  in children with ADHD, and improvements
  maintained over time.