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Delis-Kaplan Executive Function System (D-KEFS)
Availability
Please visit this website for more information about the instrument: Delis-Kaplan Executive Function System (D-KEFS)
Classification
Supplemental – Highly Recommended: Cerebral Palsy (CP), Myalgic encephalomyelitis/Chronic fatigue syndrome (ME/CFS) for overall executive function and Stroke (based on study type, disease stage and disease type)
 
Supplemental: Epilepsy, Huntington’s Disease (HD), Mitochondrial Disease (Mito), Multiple Sclerosis (MS), Sport-Related Concussion (SRC), and Traumatic Brain Injury (TBI).
 
Exploratory: Friedreich’s Ataxia (FA)
Short Description of Instrument
The Delis-Kaplan Executive Function System™ (D-KEFS™) is the first nationally standardized set of tests to evaluate higher level cognitive functions in both children and adults.
With nine stand-alone tests, the D-KEFS™ comprehensively assesses the key components of executive functions believed to be mediated primarily by the frontal lobe.
 
Engaging Materials: Its game-like format is engaging for examinees, encouraging optimal performance without providing “right/wrong” feedback that can create frustration in some children and adults.
 
Multiple Uses:
  • Assess the integrity of the frontal system of the brain
  • Determine how deficits in abstract, creative thinking may impact daily life
  • Plan coping strategies and rehabilitation programs tailored to each patient’s profile of executive-function strengths and weaknesses
 
Two Forms:
D-KEFS™ offers two forms: The Standard Record Forms include all nine D-KEFS™ tests, while the Alternate Record Forms include alternate versions of D-KEFS™ Sorting, Verbal Fluency, and 20 Questions Tests. An alternate set of Sorting Cards is also available.
 
Correlates with the California Verbal Learning Test–II (CVLT-II):
D-KEFS™ is correlated with the CVLT–II, providing information concerning the role of memory on D-KEFS™ performance.
Scoring
Each subtest generates one or more scaled scores and percentiles characterizing performance in relation to typically performing controls. Administrators can also elect to calculate optional process scores that provide cumulative percentile ranks characterizing performance strategies. Contrast scores are also available within each subtest to assess the degree to which performance is affected by aspects of cognitive functioning (e.g., motor speed or inhibition or cognitive flexibility). Scoring may either be done manually or using computer software.
Rationale/Justification
Strengths/Weaknesses: The battery provides an updated normative sample for several classic neuropsychological tests of executive function and has been widely employed in research and clinical use.
Mitochondrial Disease-Specific:
Advantages: Analogous subtests (Stroop/Color Word, Trail Making Test) have been found to differentiate individuals with symptomatic mitochondrial disorders from asymptomatic carriers and controls (Sprouse et al., 2014). The test has been validated for use in a variety of populations including multiple sclerosis, Parkinson's Disease, and Autism Spectrum Disorders, suggesting that it is a valid measure for use in a mitochondrial disorder population as well (Delis et al., 2004). Materials are engaging, and clinicians and researchers can select a subset of tests within the battery to assess specific executive skills that are of interest to them providing an opportunity to minimize fatigue. Selected subtests of the D-KEFS have been shown to differentiate performance in individuals with multiple sclerosis, even after controlling for depression, suggesting that this may be a more sensitive instrument for detecting executive dysfunction than other instruments in populations, like mitochondrial disorder, that may be at higher risk of developing co-occurring psychiatric symptoms (Parmenter et al., 2007).
Limitations: The test is normed for use in those aged 8 and above and is fairly demanding in terms of language skills. The Tower subtest is particularly demanding of fine motor speed and coordination, and the Verbal Fluency and Color-Word Interference subtests require rapid verbal responding. It is not appropriate to administer to individuals with lower IQs or to individuals with more motor involvement. The instrument may be slightly less sensitive than other measures for executive dysfunction in pediatric medical populations (Parrish et al., 2007), and test scores may exaggerate discrepancies between IQ and executive dysfunction for individuals at the very high and very low end of the IQ distribution (McGee et al., 2009)
 
Sport-Related Concussion-Specific:
Trail Making Test: Advantages: The D-KEFS trail making test represents one of a battery of updated and newly normed executive tests. The trail making test in this iteration allows for a process based analysis of the specific difficulty that drives potential poor performance on the switching aspect of Trails B.
Well normed versions of pre-existing tests of executive function. Some of the subtests have been used with TBI, though less published with mild TBI. Adults > children.
Limitations: While thorough, the measure is long to administer and there are no studies in mild traumatic brain injury demonstrating comparative superiority to the traditional Trail Making Test.
Verbal Fluency: Advantages: The D-KEFS Verbal Fluency task assess phonemic and categorical fluency but adds a category switching paradigm, increasing cognitive demand and adding a further executive component to this language generation task. Limitations: Though used widely with individuals with neurologic disorders, this is not specific to concussion nor has it been tested in this population.
Age Range: 8–89 years
 
ME/CFS-Specific:
Recommended modules for ME/CFS are: Color-Word-Interference Test, Trail Making Test, and Verbal Fluency. No summary score available if only these components are administered, but standard scores provide good interpretative guidance. This test is highly recommended, because in addition to individual subtest scores, it provides an algorithm to predict the overall executive function score from the 3 subtests mentioned above. These three components take 15-20 minutes to complete.
References
Delis DC, Kaplan E, Kramer JH. Delis-Kaplan Executive Function System™ (D-KEFS™) [Internet] 2001. Available from: http://www.pearsonclinical.com/psychology/products/100000618/deliskaplan-executive-function-system-d-kefs.html?Pid=015-8091-108.
 
Delis DC, Kramer JH, Kaplan E, Holdnack J. Reliability and validity of the Delis-Kaplan Executive Function System: an update. J Int Neuropsychol Soc. 2004;10(2):301‒303.
 
McGee CL, Delis DC, Holdnack JA. Cognitive discrepancies in children at the ends of the bell curve: a note of caution for clinical interpretation. Clin Neuropsychol. 2009;23(7):1160‒1172.
 
Parmenter BA, Zivadinov R, Kerenyi L, Gavett R, Weinstock-Guttman B, Dwyer MG, Garg N, Munschauer F, Benedict RH. Validity of the Wisconsin Card Sorting and Delis-Kaplan Executive Function System (DKEFS) Sorting Tests in multiple sclerosis. J Clin Exp Neuropsychol. 2007;29(2):215‒223.
  
Sprouse C, King J, Helman G, Pacheco-Colon I, Shattuck K, Breeden A, Seltzer R, VanMeter JW, Gropman AL. Investigating neurological deficits in carriers and affected patients with ornithine transcarbamylase deficiency. Mol Genet Metab. 2014;113(1-2):136‒141.
 
Sulheim D, Fagermoen E, Sivertsen ØS, Winger A, Wyller VB, Øie MG. Cognitive dysfunction in adolescents with chronic fatigue: a cross-sectional study. Archives of Disease in Childhood. 2015;100(9):838–844.
Recommended Instrument for
CP, Epilepsy, FA, HD, ME/CFS, Mito, MS, SRC, Stroke and TBI
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