With over 750 administrations across four languages, the tablet-based standardized assessment of executive function skills, “EF Touch in Tangerine” is effectively capturing childhood EF skills in remote and resource-limited settings.

Executive function skills are higher-order cognitive processes that allow one to initiate and pursue goal-directed behavior. These skills develop rapidly in early childhood and are consistent predictors of school readiness, self-regulation, and academic achievement. The EF Touch (Willoughby & Blair, 2016) is a computerized battery of EF tasks which take existing neuropsychological paradigms for measuring subdomains of EF skills (inhibitory control, working memory, and cognitive flexibility) and present them in a game-like fashion. This battery has been used to index EF skills in preschool-aged samples in the United States and other minority-world settings for over a decade. These EF tasks are now available in a tablet format through the Tangerine interface, with over ten tasks now available in Tangerine’s toolbox. These include:

• Silly Sounds Stroop (inhibitory control)

• Animal Go/No Go (inhibitory control)

• Something’s the Same (cognitive flexibility)

• Hearts and Flowers (inhibitory control, cognitive flexibility)

• Sun-Star / Mango-Banana (inhibitory control, cognitive flexibility)

• Spatial Conflict Arrows (inhibitory control, cognitive flexibility)

• Pick the Picture (working memory)

• Animal Location (working memory)

• Forward Span & Backward Span / Short Memory (working memory)

• Dog-Chicken (inhibitory control, vigilance)

• Bubbles (processing speed / simple reaction time)

Tangerine’s EF Touch overcomes the typical challenges of EF assessment in remote and resource-limited settings, including ensuring consistent training for assessors, maintaining standardization over time, and safely processing and sharing data amidst technological constraints. Traditional methods often rely on cumbersome processes that are susceptible to human error, data loss, and cultural mismatches. In the EF Touch in Tangerine, standardized scripts and programmed skip logic reduces administrator drift and takes the burden off assessors from making real-time administration decisions. Assessments can be administered and stored without Internet connection, then synced to the cloud when internet access is available.  Collaborators anywhere can export identified or de-identified data to monitor quality and perform data analyses. A tablet is the only required assessment material, and interfacing with the tablet can be demonstrated to children with little prior exposure.

Importantly, tasks are easily translated and adapted to support cultural validity. To date, Tangerine tasks have been translated and administered in English, Kiswahili, Chichewa, and Luo. As an example of continued adaptation, researchers administering the Tangerine EF Touch in Kenya suspected that cartoon drawings of suns and stars, which were used in a version of a spatial conflict task, were likely to be unfamiliar to participating children. In response, these stimuli were replaced with well-known fruits.

Tasks not currently in the EF Touch in Tangerine Interface be developed at the request of the collaborating research team. For example, a task that captures both inhibitory control and vigilance was recently developed for the Tangerine interface and is now in deployment.  This task requires children to touch the tablet as quickly as they can when they see a chicken (go) but inhibit touching the tablet when they see a dog (no-go). Chickens are displayed frequently at the beginning of the task, such that children develop a pre-potency for touching the tablet (to index inhibitory control). By the end of the task, chickens are rarely presented (to index vigilance).

Dr. Sarah Benki-Nugent and her research team from the University of Washington are now using the EF Touch in Tangerine in a sample of children in Nairobi, Kenya at age three years. The study is focused on the impact of air pollution on neurodevelopment and her team was especially interested in looking at executive function.  However, there are few age-appropriate, easy to administer options for assessing this outcome that are appropriate for Kenyan children. A revised EF Touch battery including tasks that were tailored for children at age three was co-developed by the RTI and Benki-Nugent’s team at UW and in Kenya and is now being used for this study.  Thus far, most children have been able to complete the simplified battery, and assessors enjoy using the battery. The team is looking forward to data analysis.