Effects of multilevel neuropsychological group intervention (EXAT) in children with executive functioning and attention deficits: a comparative study with typically developing controls

Abstract

Objective: This study examined the effects of the multilevel EXAT (Rehabilitation of Executive Function and Attention) intervention on executive function (EF) in Finnish children with EF and attention deficits, compared to typically developing (TD) controls who received no EF intervention. Method: The study included 59 children aged 7–12 years with EF deficits and 78 age-matched non-intervention TD controls. The EXAT intervention lasted 9 months and comprised weekly sessions for children, monthly parent sessions, and 2–3 school consultations. Parent-rated EF intervention effects were assessed using the Behavior Rating Inventory of Executive Function (BRIEF). Baseline and post-assessment BRIEF T-scores were compared between groups using t-tests, reliable change indices were calculated for individual EF changes, and linear regression analyses were used to explore associations between background variables and EF changes. Results: Children in the EXAT group showed significant improvements across all BRIEF indices and subscales, with small to moderate effect sizes. Individual-level analysis indicated that 22%–41% of participants achieved reliable EF improvements, mainly those with severe initial deficits. The control group exhibited minor, clinically insignificant changes. Conclusion: EXAT positively impacted EF, especially in behavior regulation and metacognition among children with substantial deficits. However, about one-quarter continued to experience EF challenges after the intervention. Findings highlight the importance of individualized assessment and intervention planning within group settings to address diverse EF profiles. Tailoring support to each child’s strengths and weaknesses is essential for optimizing outcomes. Further research with larger, diverse samples and multi-informant assessments is needed to confirm results and examine long-term effects.