To further investigate the usefulness of 3 purported
measures of executive function (EF) in head injured children,
we administered the Twenty Questions Test (TQT), Tower
of London (TOL), and the Wisconsin Card Sorting Test (WCST)
to 151 children who had sustained a closed head injury
(CHI) of varying severity about 3 years earlier. In addition,
we tested 89 normal controls. Fifty-seven of the patients
were included in a longitudinal study that compared performance
at 3 months and 36 months. All of the head injured children
underwent magnetic resonance imaging for investigational
purposes. Severity of CHI, as defined by the lowest Glasgow
Coma Scale (GCS) score, affected performance on all 3 EF
measures. Focal lesion volume incremented prediction of
performance on TOL and WCST, but not TQT. Moderate intercorrelations
of the test variables were obtained. Although all three
EF measures depicted changes in performance over 3 years,
a ceiling effect detracted from the sensitivity of the
TOL to the impact of CHI on development. Implications of
the findings for clinical applications are discussed. (JINS,
1997, 3, 598–607.)