Two considerations for the FAVRES with bilingual patients

Is the Functional Assessment of Verbal Reasoning and Executive Strategies (FAVRES) an appropriate test of executive function (EF) for bilingual patients with mild traumatic brain injury (mTBI)? Maybe, but use with caution. Ratiu & Azuma compared “bilingual” participants with and without a history of mTBI on the FAVRES, self reports of EF, and a nonlinguistic measure of EF/ inhibition (the flanker test). The participants were all college students, ranging in language background from fully bilingual non-native English speakers to native English speakers with “at least basic proficiency in Spanish.”

What did they find?

The participants with mTBI performed significantly worse than the controls on the accuracy, rationale, and reasoning portions of the FAVRES. And the scores on the FAVRES were mostly consistent with the results of the flanker test and self-reported symptoms (worse symptoms, worse FAVRES score).

Sounds promising. Why the caution? 

  • 20% of the non-brain injured bilingual controls also fell at or below the FAVRES cutoff for brain injury. Not good. Especially because these are all college students, who are presumably functioning at a pretty high level. Therefore, expect that the FAVRES may make your bilingual patients look worse than they really are.

  • The mTBI group in this study may not have the same kind of bilingual background as your bilingual patients with mTBI. Unlike the bilingual control group, the participants with mTBI were mainly native English speakers with lower Spanish proficiency. Bilingualism and being a non-native speaker of the test language could potentially have two separate effects on EF and test performance. Statistically, the history of brain injury—not the language profile—predicted lower test scores on the FAVRES. But, we don’t know quite how the results might be different with a larger, more diverse bilingual mTBI group.


Despite its limitations, this study provides enough evidence to support using the FAVRES as one tool to assess EF strengths and weaknesses in your bilingual patients with mTBI. Just remember to think twice before comparing their scores with the monolingual norms—particularly if your patients are non-native English speakers.


Ratiu, I., & Azuma, T. (2019). Assessment of executive function in bilingual adults with history of mild traumatic brain injury. Brain Impairment. doi:10.1017/BrImp.2019.17