Organizational Dysfunction

cognition and behavior (including set shifting) and the experience of reward, which are
major aspects of executive functioning. COMT is also linked to methylphenidate
(stimulant medication) response in children with ADHD. Both the DRD4/7R and
COMT/Val158Met polymorphisms are also correlated with executive dysfunction in
schizophrenia and schizotypal behavior.
Testing and Measurement
There are several measures that can be employed to assess the executive functioning
capabilities of an individual. Although a trained non-professional working outside of an
institutionalized setting can legally and competently perform many of these measures, a
trained professional administering the test in a standardized setting will yield the most
accurate results.
Clock Drawing Test
The Clock drawing test (CDT) is a brief cognitive task that can be used by physicians
who suspect neurological dysfunction based on history and physical examination. It is
relatively easy to train non-professional staff to administer a CDT. Therefore, this is a
test that can easily be administered in educational and geriatric settings and can be
utilized as a precursory measure to indicate the likelihood of further/future deficits. Also,
generational, educational and cultural differences are not perceived as impacting the
utility of the CDT.
The procedure of the CDT begins with the instruction to the participant to draw a clock
reading a specific time (generally 11:10). After the task is complete, the test
administrator draws a clock with the hands set at the same specific time. Then the
patient is asked to copy the image. Errors in clock drawing are classified according to
the following categories: omissions, perseverations, rotations, misplacements,
distortions, substitutions and additions. Memory, concentration, initiation, energy,
mental clarity and indecision are all measures that are scored during this activity. Those
with deficits in executive functioning will often make errors on the first clock but not the
second. In other words, they will be unable to generate their own example, but will show
proficiency in the copying task.
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