Weekly Calendar Planning Activity (WCPA): Validating a Measure of Functional Cognition for Adolescents With ADHD

PURPOSE: Attention Deficit Hyperactivity Disorder (ADHD) is a highly prevalent neuro-developmental disorder which persists to adolescence and adulthood. Adolescence has been described as a transitional developmental period, distinguished by changes in physical, psychological and social development, and also associated with changes in cognition and executive functions (EF) (Cermak, 2018). There is a strong relationship between EF and ADHD, and many children, adolescents and adults with ADHD exhibit EF challenges that impact their functional performance and participation in life roles (Biederman et al., 2012; Brown, 2009). There is a need for measures of functional cognition that address the interface between cognition and participation in this population. The WCPA (Toglia, 2015) is a measure of functional cognition but its validity has not yet been established among adolescents with ADHD. The purpose of this study is to examine the concurrent validity of the WCPA with both measures of cognition and participation.

DESIGN: A cross sectional correlational study was conducted on 30 adolescents recruited from public education system in Israel, ages 12.3-17.4 years (M =14.12 SD=1.50), with a valid medical diagnosis of ADHD and with no additional major neurological or psychiatric health condition (ASD, major depression, CP etc.).

METHOD: Participants completed the WCPA as a performance- based measure of functional cognition. To examine the cognitive aspects of ADHD the participants were administered the computerized MOXO-CPT test and were asked to fill out the Self-Reported Behavior Rating Inventory of Executive Function (BRIEF-SR). The parents also completed the BRIEF rating scale. Participation was evaluated with the Child and Adolescent Scale of Participation (CASP), parent and self-report version.

RESULTS: Moderate significant correlations were found between the WCPA efficiency score and the MOXO-CPT omission (r_s=.42, p=.023) and commission (r_s=.39, p=.03) errors. Moderate significant correlations were found between the WCPA accuracy score and both, the Global Executive Composite of the BRIEF parent report (r_s=-.43, p=.02) and the metacognitive index of the BRIEF-SR (r_s=-.38, p=.04). Finally, moderate to strong significant correlations were found between the WCPA accuracy score and most of the CASP parent report scores [home participation (r_s=.52, p=.006) school participation (r_s=-.45, p=.02) home and community living activities (r_s=-.62, p=.001) and CASP total score (r_s=-.54, p=.004)], as well as the CASP self-report school score (r_s=.39, p=0.4).

CONCLUSION: The findings provide support for the concurrent validity of the WCPA as a measure of functional cognition, since moderate to strong correlations were found with measures of cognition and participation. The WCPA may be a useful performance-based measure to support occupational therapy intervention for adolescence with ADHD. Further research with larger and more representative samples are needed.

References

Biederman, J., Petty, C. R., Woodworth, K. Y., Lomedico, A., Hyder, L. L., & Faraone, S. V. (2012). Adult outcome of attention-deficit/hyperactivity disorder: A controlled 16-year follow-up study. Journal of Clinical Psychiatry, 73, 941–950. https://doi.org/10.4088/JCP.11m07529

Brown, T. E. (2009). ADD/ADHD and impaired executive function in clinical practice. Current Attention Disorders Reports, 1, 37–41. https://doi.org/10.1007/s12618-009-0006-3

Cermak, S. A. (2018). Cognitive rehabilitation of children and adults with Attention Deficit Hyperactivity Disorder. In N. Katz & J. Toglia (Eds.), Cognition across the lifespan, (4th Ed.) (pp. 189-217). Bethesda, MD: AOTA Press.

Toglia, J. (2015). Weekly Calendar Planning Activity (WCPA), A performance test of executive function. Bethesda, MD: AOTA Press.