Environmental factors and daily functioning levels among adolescents with executive function deficits


Yael Fogel, Department of Occupational Therapy Ariel University, Israel
Sara Rosenblum, Department of Occupational Therapy University of Haifa, Israel
Naomi Josman, Department of Occupational Therapy University of Haifa, Israel


Adolescents with executive function deficits (EFD) often struggle to organize and self-regulate their daily functioning and participate in different environments, which can lead to long-lasting cognitive, academic and social difficulties. Their parents report significantly fewer environmental supports and more environmental barriers to their children’s participation than do parents of adolescents without EFD. Despite recent interest in these environmental factors, little research has examined their impact on participation with a focus on specific factors, different settings, or diverse populations in terms of age or difficulties. This study aimed to determine and analyse environmental characteristics that might affect adolescents with or without EFD, as perceived by their parents.


Forty-one parents of adolescents (10–14 years) with EFD and 40 parents of a matched group without EFD completed the Behavior Rating Inventory of Executive Function, the Participation and Environment Measure for Children and Youth (PEM-CY) Part B and the Child Evaluation Checklist (CHECK). Correlation and discriminate analyses were used to compare environmental factors (PEM-CY) across groups and identify those that predict daily functioning (CHECK).


Based on discriminant function analysis, 91.4% of participants were correctly classified into their respective groups (90.2% of participants with EFD and 92.5% without EFD).

Significant between-group differences were found for most environmental factors, illustrating that parents of adolescents with EFD generally perceive environmental factors as more obstructive than do parents of adolescents without EFD. For example, in home-, school- and community-environment activities respectively, 70.7%, 82.9% and 56.1% of parents of adolescents in the group with EFD rated the activities’ cognitive demands as limiting their children’s participation versus 7.5%, 12.5% and 2.5% of parents of adolescents without EFD.  

Additionally, significant negative correlations were found between school-environment activities’ social demands and the CHECK-A (r = -.48, p = .001) and CHECK-B (r = -.52, = .001), and between community-environment activities’ social demands and the CHECK-A (r = -.57, p < .001) and CHECK-B (r = -.32, p < .04). The community-environment activities’ social demands predicted 32% of the variance in the CHECK-A (R= .30, p < .001) and 6% of the variance in school-environment activities’ social demands (R= .35, p < .05). The school-environment social demands predicted 27% of the variance in the CHECK-B (R= .25, p = .001).


The tension between environmental demands and personal competencies and strengths can challenge adolescents with EFD. Analysing the supporting and inhibiting environmental factors is an inseparable part of the occupational therapy treatment for adolescents with EFD to improve their daily functions. Environmental requirements and societal expectations only increase with age; ultimately, adolescents must deal with them effectively and independently. The results of the study reinforce the need to help adolescents practice socially demanding occupations in a supported context, make adaptations, and facilitate the activity’s social demands to improve daily functioning in the school and community environments for adolescents with EFD.

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