Motor executive function was derived from the administration of items selected from 3 domains of the neuropsychological battery, NEPSY: sensorimotor, visuospatial and attention-executive. In this test standardized scores can be derived from core items, to which may be added supplemental items to derive additional information about performance in these domains.

Three visuospatial domain items: design copying, which assesses visuomotor integration by copying 2-dimensional figures on paper; arrows in which children are asked to judge line orientation and direction (scores of both are summed to produce a core domain score); and route finding, which evaluates understanding of visuospatial relationships and directionality.

Four sensorimotor domain items: fingertip tapping, which assesses finger dexterity in simple and complex movements; imitating hand postures, in which the child has to reproduce a hand position made by the examiner without assistance from the contralateral hand; visuomotor precision where the child draws inside 3 consecutively narrower tracks without overwriting the outer lines (all 3 summed for the core domain score); and finger discrimination, which assesses the child’s ability to perceive sensory stimuli without visual clues.

Four attention-executive items: the “tower,” which assesses planning, monitoring, self-regulation, and problem solving; visual attention, which assesses speed and accuracy in scanning an array of images and locating a target (these 2 scales form part of the core domain score); and we administered “statue,” where inhibition and motor persistence are evaluated during a 75-second period standing with eyes, as a measure of ability to inhibit response to distracters; and “knock and tap,” which evaluates self-regulation and ability to inhibit immediate impulses when presented with conflicting visual and verbal directions. The latter 2 scales were included as specific measures of attention, given that this is the most common area of executive problem reported in this group. The visual attention scale comprises 3 arrays, the third of which (matching 1 of 2 target faces) was abandoned because children found this too difficult and rapidly lost interest despite it being considered an age-appropriate task.

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