Executive Function in the Real World

It is well established that brain injuries adversely affect the executive functions and their development. Mark Ylvisaker had a substantial impact on how we assess and treat children and adolescents with disrupted executive functions secondary to traumatic brain injury. He articulated core principles for effective assessment and intervention that emphasized the importance of real-world meaning and application. He taught us that assessment that captures a child's everyday functioning in the context of real-world demands is often more informative than traditional neuropsychological measures alone and that interventions that improve functioning in the real-world environment are most useful. His pragmatic model influenced our own efforts to measure executive function and to develop intervention systems for children with executive function deficits. This article reviews the development of the Behavior Rating Inventory for Executive Function as an approach to ecological assessment of children and adolescents with traumatic brain injury. As we take what we learned from Mark Ylvisaker, it becomes increasingly apparent that our assessment and intervention methods, especially as related to the executive functions, demand an everyday, real-world context.