Evidence suggests over-representation of autism spectrum disorders (ASDs) and behavioral difficulties among people referred for gender issues, but rates of the wish to be the other gender (gender variance) among different neurodevelopmental disorders are unknown. This chart review study explored rates of gender variance as reported by parents on the Child Behavior Checklist (CBCL) in children with different neurodevelopmental disorders: ASD (N = 147, 24 females and 123 males), attention deficit hyperactivity disorder (ADHD; N = 126, 38 females and 88 males), or a medical neurodevelopmental disorder (N = 116, 57 females and 59 males), were compared with two non-referred groups [control sample (N = 165, 61 females and 104 males) and non-referred participants in the CBCL standardization sample (N = 1,605, 754 females and 851 males)]. Significantly greater proportions of participants with ASD (5.4%) or ADHD (4.8%) had parent reported gender variance than in the combined medical group (1.7%) or non-referred comparison groups (0-0.7%). As compared to non-referred comparisons, participants with ASD were 7.59 times more likely to express gender variance; participants with ADHD were 6.64 times more likely to express gender variance. The medical neurodevelopmental disorder group did not differ from non-referred samples in likelihood to express gender variance. Gender variance was related to elevated emotional symptoms in ADHD, but not in ASD. After accounting for sex ratio differences between the neurodevelopmental disorder and non-referred comparison groups, gender variance occurred equally in females and males.

Attention-deficit/hyperactivity disorder (ADHD) and other disruptive behavior disorders (DBD), including conduct disorder (CD) and oppositional defiant disorder (ODD), are among the most common reasons parents seek mental health treatment for their children. The undercontrolled, impulsive behaviors that characterize these disorders seem, on the surface, to be closely linked to EF skills like self-regulation and inhibitory control. While the topic of EdF has been extensively researched in ADHD, the research into EdF in other DBDs remains at a fairly early stage of development. This chapter reviews the current literature on EdF in these disorders.

The objectives of this study were to systematically develop and evaluate the psychometric properties of an abbreviated version of the Behavior Rating Inventory of Executive Function (BRIEF) Parent Report; a questionnaire widely used by pediatric neuropsychologists. A total of 24 items from the original BRIEF Parent Form were selected for the short-form, which was then evaluated in three complementary samples, according to six a priori psychometric criteria. The short-form generally demonstrated appropriate psychometric qualities, with convincing evidence for the reliability and validity of the three composite indices: Behavioral Regulation, Metacognition, and the Global Executive Composite. Potential clinical applications include screening at-risk children in medical clinics to facilitate appropriate referrals for further psychological consultation. In research settings, the short-form can be easily integrated into studies involving mass collection of data (e.g., large-scale epidemiological research), facilitating advancements in the scientific understanding of neuropsychological morbidity in medically involved populations.

Polymorphism of the dopamine transporter genotype (DAT1) confers a small but significant susceptibility to attention deficit hyperactivity disorder (ADHD). We examined whether the volume of the head of caudate, a striatal structure with high DAT expression that is important for inhibitory function, differs by DAT1 in children diagnosed with the disorder relative to age and IQ matched controls. Volume of the head of caudate was delineated in the right and left hemisphere and compared between 7‐ and 13‐year‐old children with and without ADHD (combined type) who were carriers of two (10/10) or one (9/10) copy of the 10‐repeat DAT1 allele. Caudate volumes were overall smaller in 10/10 than 9/10 children, particularly in the left than right hemisphere. While DAT1 effects did not vary by ADHD diagnosis, overall caudate volumes were smaller in ADHD relative to control children. Altered caudate development associated with 10‐repeat homozygosity of DAT1 may contribute susceptibility to ADHD. © 2010 Wiley‐Liss, Inc.

Attention deficit hyperactivity disorder (ADHD) is characterized by inattention, impulsivity, and hyperactivity mediated by frontal-striatal-cerebellar dysfunction. These circuits support implicit learning of perceptual-motor sequences but not visual-spatial context. ADHD and control children performed the Alternating Serial Reaction Time (ASRT) task, a measure of sequence learning, and the Contextual Cueing (CC) task, a measure of spatial contextual learning. Relative to controls, children with ADHD showed inconsistent ASRT learning but did not differ on CC learning. Thus, implicit sequence learning, a cognitive process mediated by frontal-striatal-cerebellar circuitry that is not under executive control, was atypical in ADHD.

Assessment of executive function has historically been confined to laboratory-based performance tests. While such tests offer the advantages of strong internal validity, control over extraneous variables, and potential to fractionate and examine components of executive function separately such as planning versus working memory, they are necessarily limited in ecological validity, or predictive value of functioning in the everyday environment. Fundamentally, executive functions are necessary for organization of goal-directed behavior in this everyday, ‘‘real world,’’ environment. Thus, in addition to assessing these functions with clinical performance measures, it is essential to also capture actual behavioral manifestation of executive function or dysfunction. This chapter focuses on measurement of executive function through assessment of individuals’ behavior in their everyday environment. First, the concept of ecological validity is discussed in relationship to assessment of executive function. This is followed by descriptions of fivemeasures that capture individuals’ executive functioning via their everyday behavior. We review the Dysexecutive Questionnaire (DEX) (Wilson, Alderman, Burgess, Emslie, & Evans, 1996), Frontal Behavior Inventory (Kertesz, Davidson, & Fox, 1997), Behavior Rating Inventory of Executive Function (BRIEF) (Gioia, Isquith, Guy, & Kenworthy, 2000), Frontal Systems Behavior Scale (Grace & Malloy, 2001), and the Executive Function Index (EFI) (Spinella, 2005). As articulated in previous chapters, the term ‘‘executive function’’ is an umbrellaconstruct for a collection of interrelated functions that are responsible for purposeful, goal-directed, and problem-solving behavior. The executive functions may be defined as the control or self-regulatory functions that organize and direct all cognitiveactivity, emotional response, and overt behavior. We view executive function as a broad umbrella term within which a set of interrelated subdomains can be defined that manifest behaviorally. Although authors vary in which functions are viewed as executive function domains, they typically include: initiation of goal-directed behavior, inhibition of competing actions or stimuli, planning and selection of relevant task goals, organization of behavior to solve complex problems, flexible shifting of problem-solving strategies when necessary, and monitoring and evaluation of problem-solving behavior. In support of these behaviors, workingmemory capacity plays a fundamental role in holding information actively ‘‘on-line’’ in the service of problem solving (Pennington, Bennetto, McAleer, & Roberts, 1996). Importantly, the executive functions are not exclusive to cognition; emotional control is also relevant to effective problem-solving activity and should be considered in any definition. Deficits in various subdomains of the executive functions are central character-istics of many developmental and acquired neurological disorders across the life span, yet their measurement can be complex and challenging. Given the central importance of the executive functions to the direction and control of dynamic ‘‘real world’’ behavior, reliance on clinic-based test performance measures potentially can yield a limited, incomplete assessment (Gioia & Isquith, 2004; Silver, 2000). While performance tests attempt to tap executive functions in explicit and specific ways, multiple confounds can limit their ecological validity and generalizability. Burgess (1997) argues that neuropsychological tests alone are inadequate for assessing executive function because they artificially and ambiguously fractionate an integrated system. Performance-based measures tap individual components of the executive function system over a short time frame and not the integrated, multidimensional, relativistic, priority-based decision making that is often demanded in real-world situations (Goldberg & Podell, 2000; Shallice & Burgess, 1991). The structured and interactive nature of the typical assessment situation mayreduce demands on the executive functions, and thereby reduce the opportunities to observe critical processes associated with the executive functions (Bernstein & Waber, 1990). That is, in many testing situations, the examiner provides the structure, planning, organization and guidance as well as the cueing and monitoring necessary for an individual’s optimal performance. In this manner, executive control is provided by the examiner (Kaplan, 1988; Stuss & Benson, 1986). As a result, individuals with substantial executive dysfunction can often perform adequately on well-structured tests when the examiner is allowed to cue and probe for more information, relieving the individual of the need to be appropriately inhibited, flexible, strategic in planning, and goal directed. Given the challenges of executive function assessment in the laboratory and theinherent limitations to applicability in the everyday environment, increasing attention is being given to alternative methods of evaluation that offer enhanced ecological validity (Silver, 2000). Assessment methods that reliably tap the individual’s everyday executive problem-solving in natural settings offer a complementary approach to clinical performance-based assessment. The challenge in assessing executive dysfunction is not only to find appropriate performance measures (tests), as Lezak (1995) and others suggest, but also to evaluate the functional, real-world impact of executive dysfunction as expressed in everyday activities. In this chapter,Executive functions andwe address behavioral assessment of executive functions as a time and cost efficient measurement method that complements traditional performance-based test methodology. We approach this problem from an ecological perspective, examining measures that capture the everyday behavior of the individual. We briefly discuss ecological validity in assessment of executive function, followed by a review of the assessment tools that use everyday behavior as the primary data source.