Self-regulation and Executive Function (EF) rely on three key types of brain function: working memory, mental flexibility, and inhibitory control. These highly interrelated skills are imperative to a child’s development. But what does this mean for children diagnosed with ADHD?

A Bit of Background

In a recently published study done by Cincinnati Children’s Hospital Medical Center, it was determined that Reflection Sciences’ Minnesota Executive Function Scale, MEFSTM, significantly predicted the severity of academic problems in children with ADHD. This study investigated the association of a performance-based measure of executive functioning with academic, social, and behavioral performance ratings in a sample of 153 children aged 5 to 12 diagnosed with attention-deficit/hyperactivity disorder (ADHD). 

In the following interview, Dr. Heather Ciesielski, a primary researcher and assistant professor for the organization, shares with us her work at CCHMC, MEFSTM, and EF screening in general


Reflection Sciences:  What is the mission of your clinic at Cincinnati Children’s Hospital?

HC:  The Center for ADHD at Cincinnati Children’s Hospital is one of the largest centers in the country devoted entirely to improving the care of children and adolescents with ADHD. The center is actively involved in clinical research and training, providing evidence-based diagnosis and treatment services for children and adolescents with ADHD, and working with community-based organizations to improve care for children with ADHD.


Reflection Sciences:  How does Executive Function fit into your work?

HC:  As a clinical psychologist who specializes in ADHD, Executive Function plays a key role in my daily practice. In evaluations, assessing EF allows me to differentiate diagnosis. In practice, I teach parents about the impact of EF weakness on their child’s behavior to help them more thoroughly understand how to use behavioral parenting strategies. I also work with middle school students and their parents to specifically target strategies to address weaknesses in areas of executive function at a critical time in their education as demands on these skills increase. 


Reflection Sciences:  What did your recently published study show regarding the MEFSTM?

HC:  In our recent study we found that children with poorer performance on the MEFSTM were associated with weaker performance, per teacher ratings, in reading, math, and written expression, and weaker performance, per parent ratings, with reading and overall school performance. This association was true beyond the severity of ADHD symptoms, further adding to the growing evidence that EF performance is an important factor in academic performance. We also found that age was not a significant moderator in our results, which may suggest that the algorithm used for the MEFSTM scoring accounts for trends in EF development, although more research on this is needed.


Reflection Sciences:  How do you view the role of EF screening and assessment in your practice?

HC:  When conducting evaluations for children with ADHD, understanding EF weakness allows me not only to more accurately make a diagnosis but also to directly tailor treatment plans to address the specific weaknesses each child is experiencing. This can be particularly beneficial for creating accommodations for school as we found in our study that the weaknesses identified via screening with the MEFSTM were associated with poorer performance in reading, math, and written expression.    

Get the scientifically proven, quantitative measure of children's Executive Function with MEFSTM

About the Clinician:

HC headshot

Dr. Heather Ciesielski conducts psychological evaluations for children ages 4 to 18, provides group-based behavioral parent training for parents of children between the ages of 3 and 12, and provides group-based academic skills training for middle school students. Her clinical and research work is primarily in Attention Deficit/Hyperactivity Disorder, with a focus on young children, including areas related to executive function, assessment, diagnosis, and treatment. Primary interests include ADHD and executive function. In addition to clinical work, Heather serves on the Bioethics committee and has a strong interest in ethics consultation and teaching.

Specialties: Child clinical psychology, Attention Deficit/Hyperactivity Disorder, executive functions, learning disabilities, comprehensive psychological evaluations, cognitive-behavioral therapy, group therapy, bioethics.