A client is instructed to generate a procedural narrative about getting ready to leave the house. This difficulty most likely reflects problems with which aspect of executive function?

• A. Verbal reasoning
• B. Cohesion
• C. Flexibility and Theory of Mind
• D. Macrostructure and organization

Answer: (D)

This item tests the ability to plan and organize a sequence into a coherent macrostructure for a procedural task. When you’re asked to generate a narrative about getting ready to leave the house, you need to create a high-level plan that lays out the overall steps in the correct order and shows how they connect, rather than just producing individual sentences. This involves sequencing: deciding what must happen first, what comes next, and what comes last, and presenting those steps in a logical flow. If someone has difficulty with this, the narrative may feel scattered or omit essential steps, because the overarching structure guiding what happens before what is not being organized effectively.

Cohesion and verbal reasoning deal with how sentences link or how conclusions follow from information, and flexibility or Theory of Mind involves adapting language to others’ perspectives. Those aspects can influence language use, but the core challenge here is arranging and presenting the overall plan and sequencing of actions, i.e., macrostructure and organization. A well-structured procedural narrative would start with an intention to leave, then outline steps in order (for example, gather items, dress, check doors, then leave), using transitions to guide the reader through the sequence.