Evaluation of executive functioning in people with intellectual disabilities.
Use the CEFA, not the BADS-C, when testing executive function in adults with mild–moderate ID to avoid false floor scores.
01Research in Context
What this study did
Researchers gave two executive-function (EF) tests to the adults with mild–moderate intellectual disability. One test was the CEFA, a new EF battery made for ID. The other was the BADS-C, a child test often used off-label.
They also gave IQ tests and checked if the EF scores matched the usual three-part EF model seen in the general population.
What they found
The CEFA worked: most adults could finish it and scores spread across the range. The BADS-C did not: over half of adults scored zero or near-zero, a classic floor effect.
The EF structure in the ID group looked like the typical model—working memory, inhibition, and shifting hung together the same way.
How this fits with other research
Poppes et al. (2010) extends these findings by showing that poor EF, not low IQ, leads adults with ID to make single-cue financial decisions. Together, the papers say EF matters for real-life choice making, and we now have a tool (CEFA) that can measure it.
Su et al. (2008) seems to disagree: they found verbal memory, not EF, predicted daily living skills in ID. The difference is the outcome—C-Y looked at broad adaptive skills while the current paper and P et al. focus on decision-making tasks that tap EF directly.
Drijver et al. (2025) faced the same floor-effect problem, but with adaptive behavior. Their new DIAB scale gives fine-grained scores for moderate–profound ID, just as the CEFA does for EF in mild–moderate ID. Both papers push us to drop old tools that bottom out.
Why it matters
If you assess EF in adults with mild–moderate ID, reach for the CEFA first and skip the BADS-C. A zero score on BADS-C does not mean zero skill; it means the test is too hard. Pair the CEFA with real-world tasks like financial choice checks to see if EF gains transfer to safer, more independent lives.
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02At a glance
03Original abstract
BACKGROUND: Executive functioning (EF) is an important concept in cognitive psychology that has rarely been studied in people with intellectual disabilities (IDs). The aim of this study was to examine the validity of two test batteries and the structure of EF in this client group. METHODS: We administered the children's version of the Behavioural Assessment of the Dysexecutive Syndrome (BADS-C) and the Cambridge Executive Functioning Assessment (CEFA) for people with ID, to 40 participants who attended day centres for people with mild to moderate learning disabilities [mean full-scale intelligence quotient (IQ) = 59]. The BADS-C consists of six EF subtests while the CEFA contains eight EF (including two executive memory) subtests and four memory subtests. IQ and receptive language ability were also assessed. The results were subjected to principal components analysis, and regression analysis was used to examine the relationship of the ensuing factors to other cognitive variables. RESULTS: Scores on both sets of EF tests were only weakly related to receptive language ability, and even more weakly related to IQ. Scores on the BADS-C were substantially lower than predicted from the published norms for people in higher IQ ranges, and many participants scored zero on three of the six subtests. This potential floor effect was less evident with scores on the CEFA. Principal components analyses produced one usable factor for the BADS-C, and two factors for the CEFA that differed in both the extent of involvement of working memory and the predominant sensory modality. A combined analysis of the subtests retained from both analyses produced three factors that related uniquely to aspects of IQ and memory. CONCLUSIONS: The CEFA is suitable for use with people with mild to moderate learning disabilities, whereas the BADS-C is at the lower limit of usability with this client group. The lower-than-expected scores observed on the BADS-C may indicate that people known to learning disability services may be more impaired than people of comparable IQ not known to services. The structure of EF seen in people with IDs closely resembles a model of EF in the general population that has received a broad level of support.
Journal of intellectual disability research : JIDR, 2010 · doi:10.1111/j.1365-2788.2010.01249.x