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Executive Functioning and the Emerging Adult:

The Dissonance Between Intelligence and Competence

Paule Verdier MOT, OTR/L

 

High IQ/Executive Functioning Disability

Just because an adult has a high IQ doesn’t mean that they are capable of living on their own. We have seen many examples of emerging adults who are well above average in intelligence, but lack executive functioning capabilities. The following domains describe areas of executive functioning and examples of how the emerging adults with high IQs at Yellowbrick perform on a well-established assessment tool for independent life skills functioning, the Performance-Based Assessment of Self-Care Skills (PASS).

The PASS offers the opportunity to observe patients in “real time” for two hours as they perform everyday tasks, thereby, providing the assessor with a wealth of information on the young person’s life experiences and difficulties with executive functioning. At Yellowbrick, we use the PASS because of the large discrepancy we have observed between IQ and life functioning. We have also developed our own measure to evaluate these deficiencies in more specific activities, such as using the washer and dryer, self-care and hygiene, and self-organizational patterning.

PASS was created by two occupational therapists it is a criterion-referenced assessment with two versions offered for in-home and in the clinic. Consisting of 26 tasks, although at Yellowbrick, only 17 are utilized as the remaining 9 are not appropriate for this population.

Items are rated on a predefined four-point ordinal scale. The scoring system yields three types of scores for each subtask – task independence, task safety, and task adequacy outcome. There are nine types of assistance provided, where the independence data comes from, they are: verbal supportive, verbal non-directive, verbal directive, gesture, task object or environmental rearrangement, demonstration, physical guidance, physical support, and total assist. Safety data is compiled from unsafe observations from the examiner. Task performance outcomes for a subtask that are of unacceptable quality are checked in the quality column, whereas inefficiency in the task process is checked in the process column. The scores are then summarized from the raw data (Rogers & Holm, 1989).

The following table lists the different areas of executive functioning and the subtasks of the PASS that assist in identifying difficulties in that area.

Self-monitoring & awareness Planning & organization Problem-Solving Mental flexibility & abstraction Generalization & transfer
Flashlight, Home safety, Cooking, Toenail trimming, Making a bed, Mailing bills, Shopping Managing medications, Toenail trimming, Cooking, Using the phonebook Radio broadcast & newspaper article, Flashlight, Cooking, Cleaning, Paying bills, Shopping Using the phonebook, Home safety Radio broadcast & newspaper article

Self-monitoring and awareness represent the ability to be aware of one’s own limitations and recognize deficits and problems. For example, one adult had great difficulty when to fixing a flashlight that wasn’t working properly. While attempting to take the flashlight apart she cut her thumb removing the light bulb. Another self monitoring task is to identify and correct dangerous situations created in the kitchen. Several did not notice a pair of scissors sticking out of a drawer, point up, the assessor was forced to stop people from walking into the scissors.

The steps needed to achieve and make choices reside in the executive function of planning and organization. Many of the adults exhibit the inability to follow verbal or written directions precisely in several of the subtasks. One required several prompts to follow the directions written on the medication bottles when distributing them.

Problem-solving skills are invaluable and tend to be deficient or lacking in the emerging adult population. In order to problem solve, one must attend to the problem, devise a plan, initiate activity, access information, and integrate feedback from the attempt to solve the problem. When given information through the radio announcement on the PASS, many young adults appear to not understand the underlying subject matter and do not provide a reasonable solution to the problem. Several have replaced both the light bulb and the batteries in the flashlight instead of determining which was faulty. Even after reading the directions, one emerging adult was confused by the directions on a soup can and required physical assistance to open the can. When he did not find a large bowl in the only cabinet he opened, one young man decided to use a plastic pitcher to hold muffin mix. When asked to clean the counters of the kitchen, one chose to use dish soap to clean up spills instead of a traditional cleanser.

“Mental flexibility” and “abstraction” are the abilities to think beyond concrete thought. One young woman had some difficulty finding the number to the pharmacy in the yellow pages, looking for the listing for Walgreens under W instead of P. “Generalization and Transfer” describe the ability to transfer new learning and use new information in a novel situation. There are several tasks that offer the emerging adults an opportunity to use these executive functions. When given an article to read, with the instructions that she reiterate the theme of the article and indicate something she would do differently now that she has read that information, one young woman did not understand the instructions and, instead, wanted to rewrite the article to be more precise in it’s information.