Behavioural Assessment of the Dysexecutive Syndrome (BADS)

Behavioural Assessment of the Dysexecutive Syndrome (BADS) Barbara A Wilson, Nick Alderman, Paul W Burgess, Hazel Emslie and Jonathan J Evans

• 
  Age Range: 16 to 87 years


• 
  Administration: Individual – 40 minutes

Testing for executive deficits has been difficult because traditional tests do not reflect the real life demands that are made when people have to solve problems, plan and organize their behaviour, set priorities and adapt behaviour accordingly. Previous tests have often assessed component skills of the central executive rather than executive functioning per se, and although some of them have been shown to be sensitive to frontal lobe damage, they do not reflect every day situations and consequently there is a poor relationship between test scores and the day to day problems of patients.

The authors have designed a test battery that overcomes these deficiencies by including items that are specifically sensitive to those skills involved in problem solving, planning, and organizing behaviour over an extended period of time. The battery of 6 tests thus assesses capacities that are normally exercised in daily life.

Temporal judgement – This test uses four questions to assess subjects\’ ability to estimate how long various complete events (such as a dental appointment) last.

Rule shift cards – tests the ability to change an established pattern of responding, using familiar materials. In part 1 a response pattern is established according to a simple rule. In part 2 the rule is changed and subjects have to adapt their responses, inhibiting their original response set.

Action program – tests practical problem solving. A cork has to be extracted from a tall tube, a result which can only be achieved by the planned use of various other materials provided.

Key search – A test of strategy formation. In an analogue of a common problem, subjects are required to demonstrate how they would search a field for a set of lost keys and their strategy is scored according to its functionality.

Zoo map – This is a test of planning. It provides information about subjects\’ ability to plan a route to visit six of a possible 12 locations in a zoo, firstly in a demanding, open-ended situation where little external structure is provided, and secondly in a situation that involves simply following a concrete, externally imposed strategy.

Modified six elements – This is a test of planning, task scheduling and performance monitoring. It is a simplified version of the original Shallice & Burgess (1991) test. Subjects have to schedule their time to work on six tasks over a ten minute period.

The Dysexecutive Questionnaire

The battery also includes a 20 item \’Dysexecutive questionnaire\’ (DEX). The items are constructed in order to sample the range of problems commonly associated with the DES in four broad areas of likely change: emotional or personality changes, motivational changes, behavioural changes, and cognitive changes. Each item on the DEX is rated on a 5 point scale representing problem severity. The DEX comes in two forms, one designed to be completed by the patient and one by a relative or carer.

Complete kit: Includes manual, 25 scoring sheets, 5 stimulus books, stimulus cards, three-dimensional plastic materials, timer, 25 self rater dex questionnaires, 25 independant rater questionnaires