Developing an executive functioning composite score for research and clinical trials

Grant L. Iverson, Justin E. Karr, Douglas P. Terry, Mauricio A. Garcia-Barrera, James A. Holdnack, Brian J. Ivins, Noah D. Silverberg

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Objective: Executive functioning encompasses interactive cognitive processes such as planning, organization, set-shifting, inhibition, self-monitoring, working memory, and initiating and sustaining motor and mental activity. Researchers therefore typically assess executive functioning with multiple tests, each yielding multiple scores. A single composite score of executive functioning, which summarizes deficits across a battery of tests, would be useful in research and clinical trials. This study examines multiple candidate composite scores of executive functioning using tests from the Delis-Kaplan Executive Function System (D-KEFS). Method: Participants were 875 adults between the ages of 20 and 89 years from the D-KEFS standardization sample. Seven Total Achievement scores were used from three tests (i.e., Trail Making, Verbal Fluency, and Color-Word Interference) to form eight composite scores that were compared based on their psychometric properties and association with intelligence (IQ). Results: The distributions of most composite scores were mildly to severely skewed, and some had a pronounced ceiling effect. The composite scores all showed a medium positive correlation with IQ. The composite scores were highly intercorrelated in the total sample and in four IQ subgroups (i.e., IQ <89, 90-99, 100-109, 110+), with some being so highly correlated that they appear redundant. Conclusions: This study is part of a larger research program developing a cognition endpoint for research and clinical trials with sound psychometric properties and utility across discrepant test batteries. Future research is needed to examine the reliability and ecological validity of these composite scores.

Original languageEnglish
Pages (from-to)312-325
Number of pages14
JournalArchives of Clinical Neuropsychology
Issue number3
StatePublished - 2020

Bibliographical note

Funding Information:
The data used for the analyses reported within this manuscript were provided by Pearson, Inc. (2001). Standardization data from the Delis-Kaplan Executive Function System (D-KEFS). Copyright © 2001 NCS Pearson, Inc. Used with permission. All rights reserved. San Antonio: Pearson, Inc. Grant Iverson has received research support from test publishing companies in the past, including PAR, Inc., ImPACT Applications, Inc., and CNS Vital Signs. He receives royalties for one neuropsychological test (Wisconsin Card Sorting Test-64 Card Version). He acknowledges unrestricted philanthropic support from the Mooney-Reed Charitable Foundation, ImPACT Applications, Inc., Heinz Family Foundation, and the Spaulding Research Institute. Justin Karr is a former Vanier Canada Graduate Scholar and thanks the Natural Sciences and Engineering Research Council of Canada (NSERC) for their support of his graduate studies. Mauricio Garcia-Barrera notes that this work is related in part to his grant entitled Characteristics and Correlates of Intraindividual Variability in Executive Control Processes (NSERC). In addition, he has served in the past as consultant for Pearson. James Holdnack was previously employed by Pearson, the company that owns and distributes the D-KEFS.

Publisher Copyright:
© The Author(s) 2020.


  • Assessment
  • Executive functions
  • Norms/normative studies

ASJC Scopus subject areas

  • Neuropsychology and Physiological Psychology
  • Clinical Psychology
  • Psychiatry and Mental health


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