El Salvador – Testing for Executive Functioning

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A few weeks ago I returned from El Salvador. It was a wonderful trip because we got a lot done and we also enjoyed the time we had with our friends there. (The names of the caregivers and the children in the orphanage will be changed to protect their confidentiality.) I usually over-prepare for the workshop before my arrival. I am rewarded for all that hard work by discovering that the caregivers are really focused on another subject, and I must do the presentation all over again. This time I decided I would be smarter and wait to prepare the power point until the day before. My traveling companion and colleague for this trip was Elizabeth Tedesco, a talented preschool teacher at the Cambridge Ellis School in Cambridge. I came to discover that she was a pleasant and comfortable companion, a hard worker, a great observer, and an all around terrific collaborator.

Our general plan was to assess the children for executive function – in an informal way, since neither Liz nor I are psychologists. I had been doing some thinking after my India trip – and also considering my skypes with Rachel – I decided that school problems were the most important focus for us right now. The commonest problem facing the children in both places seemed to be executive function problems (EFD) – organization, initiation, follow through. It made sense to me that this would be the case, because in addition to all the reasons my middle class child patients have EFD, children in the low SES population of developing countries may have the additional risk factors of malnutrition, poor health care, neglect, and trauma. That means, according to Perry’s developmental model of the brain (Perry & Dobson, 2008, the infrastructure is weak and regardless of how intelligent the child’s thinking brain is, he or she will not be able to assimilate and integrate information and produce good schoolwork.

A colleague told me about Betsy Kammerer’s work to develop an assessment tool in Africa, and I called her (Kammerer, Isquith, & Lundy, 2013). Betsy is working mostly with very young children, but she agreed with me that assessing for EFD would be most cost effective, given the likelihood that the children in our population would have this problem, and also given that there are strategies designed to help them. She also wondered whether the children in our population might be culturally unprepared to take a test themselves and thought that it might be better to give questionnaires to caregivers. She recommended the BRIEF assessment tool as an easy to do questionnaire for parents and teachers. She cautioned me about the importance of a good translation. When I looked up the BRIEF, it said that a Spanish translation was coming out soon, but I couldn’t wait, so I asked Liz and “Mona” (the education director at the children’s home) to take a try. Liz translated the parent questionnaire and Mona got a native Salvadoran friend to do the teacher questionnaire. Then Liz checked her parent questionnaire against the Salvadoran one, since the items are almost all the same in the two questionnaires. Liz and I were excited to get to work.

This time we flew through Atlanta. In Atlanta, the scene changed from middle class white American travelers, including business people, no upgrades available to first class, to the San Salvador gate. There the culture already is different. People are traveling mostly in families. First class has empty seats. The trip was pleasant and uneventful. When we arrived in San Salvador and entered the arrival lounge and immigration, the tropical air swallowed us in a hot humid blanket. Birds squawked in the palm trees. We had arrived. The director of child care (“Sarah”) met us outside immigration. We drove in the red pick up truck to the orphanage to see it in its new location, and then we headed to our first school observation.

Kammerer B, Isquith P, Lundy S (2013).  Approaches to assessment of very young children in Africa in the context of HIV, in M Boivin & Giordani (eds), Specialty Topic in Pediatric Neuropsychology, Neuropsychology of Children in Africa, Perspectives on Risk and Resilience, Springer.

Perry B, Hambrick E (2008), The neurosequential model of therapeutics, www.reclaiming.com, Vol. 17, No. 3, pp 39-43.


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