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Executive Skills in Children and Adolescents

A Practical Guide to Assessment and Intervention

Froehlich, Tanya E., M.D.

Journal of Developmental & Behavioral Pediatrics: June 2006 - Volume 27 - Issue 3 - p 279
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Cincinnati Children's Hospital Medical Center, Cincinnati, OH

Executive Skills in Children and Adolescents: A Practical Guide to Assessment and Intervention by Peg Dawson and Richard Guare, New York, NY: The Guilford Press, 2004, 129 pp., US$27 (paperback).

Executive functions-the cognitive processes required to plan and direct activities and behavior-are essential to success at both school and home, yet few comprehensive resources to help children build these skills are available. Therefore, Executive Skills in Children and Adolescents fills an important need. Dawson and Guare have designed this manual to give clinicians and educators practical supports for planning executive skills assessments and interventions, with tools included that can be used by families.

The authors deserve praise for using clear, largely nontechnical language and filling Executive Skills with real-world examples. Chapter 1 provides an overview of 11 executive function domains, including task initiation, sustained attention, performance monitoring, and inhibition of impulses. Chapter 2 describes multimodal methods of assessing executive skills, including use of classroom observation, interviewing, behavior checklists, and formal neuropsychological measures. Chapter 3 outlines the process of linking assessment to intervention. Chapters 4 to 6 focus on interventions to promote executive skills. Chapter 4 provides a broad overview of intervention strategies; in addition, it includes a table of suggested interventions for each executive function domain. Chapter 5 highlights coaching as a general strategy to improve executive skills. Chapter 6 provides teachers with classroomwide techniques to address the executive function weaknesses of many children simultaneously Chapter 7 discusses the presentation of executive skills in special populations, such as children with traumatic brain injury, attention-deficit/hyperactivity disorder, and sleep disorders. Dawson and Guare finish with an Appendix of forms and checklists that can be used for assessing executive functions and developing interventions.

Executive Skills has a number of notable strengths, including its accessibility to a broad audience and use of case illustrations. The suggested interventions are practical and specific, including both environmental modifications and guidelines on teaching each executive skill. In addition, Dawson and Guare provide a number of easy-to-read tables summarizing their recommendations throughout the text. Its Appendix, which contains numerous ready-to-photocopy assessment tools, checklists, and intervention planning sheets, is another particularly nice feature. The Guilford Press has granted purchasers of the book permission to reproduce selected materials for professional use.

However, as the authors rightly caution in their Concluding Comments, Executive Skills is not a "magic bullet" for the management of every student. Because many of the manual's suggestions are time- and labor-intensive, they are not optimal for children, parents, and/or teachers who lack perseverance and motivation. In addition, readers should be aware that Dawson and Guare's descriptions of the different executive function domains are not always congruent with the typical definition of these constructs in neuropsychology research or standardized testing. For example, in Executive Skills, forgetting to hand in homework is considered evidence of "working memory" impairment; in contrast, a more short-term construct is tapped in most formal neuropsychological measures of "working memory." However, these occurrences do not diminish the utility of Executive Skills, because it is intended as a practical support for children struggling with executive skills, not a research tool or guide.

Overall, Executive Skills in Children and Adolescents: A Practical Guide to Assessment and Intervention shows great promise as a helpful addition to the developmental-behavoral specialist's clinical armamentarium. Although its suggestions for assessment and intervention are largely "tried and true" rather than completely novel, Executive Skills is unique in the breadth and specificity of its recommendations for children with executive function impairments.

Tanya E. Froehlich, M.D.

Cincinnati Children's Hospital Medical Center

Cincinnati, OH

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© 2006 Lippincott Williams & Wilkins, Inc.