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Despite the prevalence of executive dysfunction across multiple neurological and psychiatric conditions, there have been few validated rehabilitative interventions targeting it. One intervention holding promise for patients with executive dysfunc­tion is Robertson’s Goal Management Training (GMT; Robertson, 1996). GMT is based on Duncan’s (1986) theory of goal neglect (or failure to execute intentions), in which disorganized behavior is attributed to impaired construction and use of “goal lists,” considered to direct behavior by controlling actions that promote or oppose task completion. GMT attempts to ameliorate goal neglect through verbally mediated, metacognitive strategies that systematically target planning abilities by teach­ing individuals to structure their intentions. Through presentations, discussions, exercises, and homework assignments, GMT trains participants to use strategies like stopping and orienting to relevant information, partitioning goals into more easily managed subgoals, encoding and retaining goals, and monitoring performance. Investigations into the efficacy of GMT have been promising in both normal older adults and in patients with acquired brain injury (ABI). In order to investigate the efficacy of GMT for older adults with cognitive complaints, van Hooren and colleagues (2007) randomly assigned 69 normal, community-dwelling adults age 55 years or older to a six-week GMT program or to a waitlist control group. After the intervention, participants from the GMT group reported significantly fewer anxiety symptoms, were significantly less annoyed by their cognitive failures, and reported improved ability to manage their executive failures as com­pared to control participants. Though this study reported positive results for subjective outcome measures, the intervention showed no effect on the Stroop Colour Word Test (Houx, Jolles, & Vreeling, 1993; Stroop, 1935). Levine and colleagues (2000) reported on 30 traumatic brain injury (TBI) patients who were randomly assigned to receive a brief trial (1-hour session) of GMT or motor skills training. Upon completion of the intervention, the GMT group, but not the motor skills group, showed significant improvement on paper-and-pencil tasks designed to mimic everyday executive tasks that are problematic for patients with goal neglect.

Attention is one of the most basic cognitive processes and is a prerequisite for the use of more complex functions, since it is not possible to evaluate perception or memory processes without keeping in mind attention issues (Amador, Forns, & Kirchner, 2006). The ability to maintain an appropriate level of attention is basic for education and learning, especially during childhood and school age. With the aim of studying attention separately from other cognitive functions, the so-called continuous performance tests (CPT) were created. The first series of CPTs were developed by Rosvold, Mirsky, Sarason, Bransome, and Beck (1956) to study vigilance in adults with acquired brain injury (Riccio, Reynolds, & Lowe, 2001), more specifically, persons with seizures (Amador, Forns, & Kirchner, 2006). Nowadays, CPTs are still one of the most widely used measures for the assessment of attention and processing speed. Briefly, it can be said that a CPT is a group of paradigms to evaluate attention, inhibitory response or disinhibition (a component of executive control that provides information about the subject’s impulsivity), and processing speed. Basically, CPTs rely on the rapid, random presentation of a series of stimuli to which the subject must respond following instructions given at the beginning of the test. The main value of CPTs is their empirical support. Diverse CPT paradigms have consistently demonstrated their sensitivity for a great variety of both neurological and psychiatric disorders, in adults and in children. Frequently, CPTs also use a continuous vigilance task, in order to obtain quantitative information about the individual’s ability to sustain attention in time. From its creation, the CPT paradigm has been used with many variants of its task component. Greenberg and Walkman (1993) found up to 100 different versions of CPT in use. Historically, when Rosvold and his collaborators introduced the test, they had the goal of measuring correct answers provided by the subject as an indicator of selective attention. With subsequent experimentation, other measures, such as processing speed, impulsivity, inattention, and sustained attention, divided or alternate, have been included.