Behavior Rating Inventory of Executive Function BRIEFTM

1
Behavior Rating Inventory of Executive
FunctionBRIEFTM

• Gerard A. Gioia
• Peter K. Isquith
• Steven C. Guy
• Lauren Kenworthy
• Kimberly Espy

2
Impetus

• Clinical need for external validation, ecological
  validity, real-world anchor
• Common parent descriptions
• ALL research - observations
• Performance tests vs rating scales

3
Whats in a name

• Childrens Behavior Questionnaire
• Executive Function Questionnaire
• Developmental Executive Function Test
• Behavioral Evaluation of Executive Function
  (Youth?)
• Behavioral Assessment of Regulatory Function
• Planning and Organization Rating Questionnaire
• Parent Observation Rating Questionnaire
• Behavior Rating Inventory of Executive Function

4
The Purpose is to provide a measure of executive
function that is

• psychometrically sound
• sensitive to developmental changes
• high in ecological validity
• sufficiently broad to serve as a screen
• comprehensive in sampling content
• theoretically coherent
• useful in targeting treatment

5
Behavioral Definitions for Executive Function
Domains

• Inhibit - Control impulses stop behavior
• Shift - Move freely from one activity/situation
  to another transition problem-solve flexibly
• Emotional Control - Modulation emotional
  responses appropriately

6
Behavioral Definitions for Executive Function
Domains

• Initiate - Begin activity generate ideas
• Working Memory - Hold information in mind for
  purpose of completing a task
• Plan/organize - Anticipate future events set
  goals develop steps grasp main ideas
• Monitor - Check work, assess own performance

7
Development of the BRIEF

• Content
• Reliability
• Validity
• Age/ Gender Findings
• Modeling of Executive Function

8
Item Development

• Collected items from clinical work
• Idea generation sessions within group
• Requests from colleagues
• Review of behavior scales (CBCL/TRF, BASC,
  Conners, Vineland, Profile of Executive Control
  System, Cognitive Symptom Checklist)

9
Results of Item Development

• Items reviewed by group, colleagues, reading
  specialists
• 180 initial items redundant non-specific
• Item Tryout 129 Parent/127 Teacher
• Excess items based on item-total correlations
• Final Scale 90 items retained

10
BRIEF Inhibit

• Gets in your face
• Has trouble stopping when silly
• Is squirmy
• Does not stop laughing at joke when friends stop
• Has to be closely supervised
• Des not think before doing
• Acts wilder or sillier than others in groups
• Makes odd noises, hums, mutters or sings
• Interrupts others

11
BRIEF Shift

• Does same thing over and over for no apparent
  reason
• Is stubborn
• Cannot get a disappointment off their mind
• Resists accepting a different way to solve a
  problem
• Becomes upset with new situations
• Tries same approach to problems even when it
  doesn't work
• Acts upset by change in plans
• Not creative in problem solving

12
BRIEF Emotional Control

• Overreacts to small problems
• Explosive, angry outbursts
• Tearful easily
• Mood changes frequently
• Reacts more strongly than other children
• Becomes too silly

13
BRIEF Initiate

• Is not a self-starter
• Needs to be told to begin a task even when
  willing
• Has trouble coming up with ideas for what to do
  in play or free time
• Has trouble getting started on homework or chores
• Does not take initiative
• Complains there is nothing to do
• Lies around the house a lot (couch potato)

14
BRIEF Working Memory

• Is absent-minded
• When given three things to do, remembers only the
  first or last
• Trouble with multi-step chores
• Forgets when he was doing
• Trouble remembering things even for a few minutes
• Has a short attention span
• Has trouble completing tasks
• Is easily distracted

15
BRIEF Plan/Organize

• Tests poorly despite knowing answers
• Good ideas but can't get the job done
• Written work poorly organized
• Starts project without the right materials
• Trouble planning for future play activities
• Does not connect tonight's homework with grades
• Unrealistic Goals
• Underestimates time needed to complete tasks

16
BRIEF Organization of Materials

• Leaves playroom a mess
• Loses lunch box, lunch money, permission slips,
  homework
• Cannot find clothes, glasses, shoes, toys, etc
• Backpack is disorganized
• Forgets to hand in homework even when completed

17
BRIEF Monitor

• Doesn't ask for help when needed
• Doesn't check work for mistakes
• Makes careless errors
• Poor handwriting
• Unaware of how behavior affects others
• Leaves work incomplete

18
Reliability Internal Consistency

• Initiate
• Working Memory
• Plan/Organize
• Organization of Materials
• Monitor
• Inhibit
• Shift
• Emotional Control

• Parent Teacher
• .82 .84
• .92 .90
• .91 .87
• .88 .90
• .85 .89
• .94 .95
• .88 .91
• .92 .94

19
Reliability Internal Consistency

• Metacognition
• Behavioral Regulation
• Global Executive Composite

• Parent Teacher
• .96 .98
• .96 .97
• .98 .98

20
Reliability Test-Retest

• Scale
• Initiate
• Working Memory
• Plan/Organize
• Org of Materials
• Monitor
• Inhibit
• Shift
• Emotional Control

• Parent Parent Teacher
• Clinical Norm Norm
• .77 .80 .87
• .82 .85 .86
• .80 .85 .88
• .84 .79 .83
• .80 .76 .87
• .76 .84 .91
• .72 .78 .83
• .79 .79 .82

21
Reliability Test-Retest

• Metacognition
• Behavioral Regulation
• Global Executive Composite

• Parent Parent Teacher
• Clinical Norm Norm
• .83 .88 .90
• .80 .84 .92
• .81 .86 .91

22
Validity

• Content Item development
• Expert Agreement
• Item-Total Correlations
• Construct Multitrait-Multimethod Matrix
• Factor Structure
• Clinical Group Comparisons

23
Construct Validity - Factor Analysis

• Allows examination of the structure of the BRIEF
  to assist in clinical scale/ index development
• Resulting factors can serve as clinical entities
  meta-scale (latent) structural factors
• Various extraction methods PFA, PCA
• Various rotational methods Varimax, oblique

24
Summary of Exploratory FA

• Consistent 2-factor model found with normative,
  clinical samples BRIEF factors differentiate
  from other behavior rating scale factors.
• Metacognition
• Initiate, Working Memory, Plan/Organize,
  Organization of Materials, Monitor
• (Inhibit)
• Behavioral Regulation
• Inhibit, Shift, Emotional Control
• (Monitor)

25
The Structure of Executive Function

• Interest in BRIEF goes beyond its use as a
  clinical tool
• Allows an opportunity to explore the theoretical
  structure of executive function (EF)
• Others have asked whether EF is a unitary or
  fractionated supervisory/ regulatory system
• Theory testing also can assist our approach to
  clinical application of the BRIEF as a measure of
  EF

26
Diagnostic Group Studies

• ADHD-Inattentive vs ADHD-Combined
• BRI and Monitor Combined gt Inattentive
  Controls
• MCI Both ADHD groups gt Controls
• B. Pratt, F. Campbell-LaVoie, P. Isquith, G.
  Gioia S. Guy
• P. Isquith, G. Gioia S. Guy
• Severe vs Mild/Moderate TBI
• BRI Init, Plan/Org, WM, Monitor Severe gt
  Controls
• Working Memory Severe gt Mild/Moderate gt
  Controls
• H. G. Taylor et al.
• TS vs ADHD vs TSADHD
• BRI MCI ADHD TSADHD gt TS Controls
• E. M. Mahone

27
Diagnostic Group Studies

• Reading Disorders
• Working Memory Reading gt Controls
• Plan/Organize Reading gt Controls
• B. Pratt, F. Campbell-LaVoie, P. Isquith, G.
  Gioia S. Guy
• Extremely Low Birth Weight vs VLBW
• Monitor, WM, Shift, Inhibit, Init, Plan/Org ELBW
  gt Controls
• Initiate Plan/Org ELBW gt VLBW
• . G. Taylor et al.
• Mental Retardation
• Working Memory MR gt Controls
• B. Pratt T. Chapman

28
Diagnostic Group Studies

• High Functioning Autism
• All BRIEF Scales HFA gt Controls
• R. Landa M. Goldberg
• Pervasive Developmental Disorders
• All BRIEF Scales PDD gt Controls
• L. Kenworthy S. Guy
• Frontal vs Extrafrontal Lesions
• All Scales Frontal Extrafrontal gt Controls
• Inhibit Frontal gt Extrafrontal gt Controls
• R. Jacobs, V. Anderson, S. Harvey

29
Conclusion

• The BRIEF is a reliable and valid behavior
  rating scale of executive functions in children
  and adolescents that can (a) become an integral
  part of the clinical and school assessment of
  children and adolescents and (b) assist with
  focussed treatment and educational planning for
  children with disorders of executive function.
  (Gioia, Isquith, Guy Kenworthy, 2000, p. 4)

30
Clinical Implications

• Two factors and component parts are to be
  considered in interpretation
• Behavioral Regulation, esp. Inhibit, must be
  considered first prior to Metacognition
• Treatment of Behavioral Regulation is likely a
  necessary precursor to Metacognition treatment
• Treatment of metacognition via active
  problem-solving strategies

31
BRIEF Administration and Scoring
32
BRIEF Administration and Scoring

• Intro to Forms - Parent, Teacher
• Scoring Sheet
• Scoring Summary
• Profile Sheet
• Case Example

33
(No Transcript)
34
(No Transcript)
35
(No Transcript)
36
(No Transcript)
37
(No Transcript)
38
(No Transcript)
39
(No Transcript)
40
(No Transcript)
41
(No Transcript)
42
(No Transcript)
43
(No Transcript)
44
Steps to BRIEF Interpretation

• Examine validity scales
• Inconsistency
• Negativity
• Examine clinical scales
• Examine Indexes, Global Executive Composite
• Individual item analysis
• Within scale items
• Non-scale items

45
Son of BRIEF The BRIEF-Preschool Version

• Gerard A. Gioia
• Kimberly Andrews Espy
• Peter K. Isquith

46
OrThe Developmental Inventory Assessment of
Preschool Executive Regulation

• (DIAPER)

47
Executive Function in Preschoolers Common View

• Young children
• lack inhibitory control
• exhibit significant distractibility
• have difficulty shifting among tasks
• do not organize, plan, or monitor their actions
  or performance

48
Views from Developmental Neuropsychology

• Executive functions DO originate in infancy
• BUT, not available in full final form
• HOWEVER, measurement is possible if
  developmentally appropriate tasks are used
• AND, we must take into account the preschoolers
  behavioral repertoire

49
BRIEF-Preschool Version

• Sample n450 Parents, 300 Teachers
• Age 2- 5 years
• Diverse sample ethnically, regionally, SES
• 129 97 63 items

50
BRIEF-P Domains

• Inhibit
• Shift
• Emotional Control
• Working Memory
• Plan/ Organize
• Organization (of Materials)
• Monitor
• Initiation

51
Reliability Internal Consistency

• Working Memory (17)
• Plan/Organize (10)
• Inhibit (16)
• Shift (10)
• Emotional Control (10)

• Parent Teacher
• .88 .95
• .80 .86
• .90 .95
• .85 .90
• .86 .94

52
Stability of Preschool Executive BehaviorsTest
- Retest Reliability

• Scale r
• Inhibit .90
• Shift .88
• Emotional Control .87
• Working Memory .85
• Plan/Organize .78
• Test-Retest Interval 1 - 9 weeks, M 4.5 weeks

53
BRIEF-P Construct Validity

• Factor 1 Emergent Metacognition
• Factor 2 Flexibility
• Factor 3 Inhibitory Self-Control.

54
Percentage of Dx Groups With Tgt 65 on BRIEF-P
Scales
Diagnostic Group Diagnostic Group Diagnostic Group Diagnostic Group Diagnostic Group
Scale Controls Preemie Language ADHD PDD
Inhibit 7.2 11.8 32.1 76.5 87.5
Shift 7.2 20.6 28.6 29.4 68.8
Emotional Control 6.3 8.8 28.6 47.1 75
Working Memory 9.6 35.3 39.3 70.6 75
Plan/Organize 2.8 17.6 28.6 76.5 56.3
Inhibitory Self-Control Index 6.3 14.7 28.6 76.5 93.8
Flexibility Index 6.7 8.8 28.6 29.4 75
Emergent Metacognition Index 7.0 29.4 32.1 70.6 68.8
Global Executive Composite 6.5 17.6 35.7 70.6 81.3
55
Clinical vs Control Samples





p lt .001
56
Bride of the BRIEF

• The BRIEF-Self-Report

57
Scale Number of Items Behavioral description
Clinical scales
Inhibit 13 Controls impulses and behavior appropriately stops and modulates own behavior at the proper time or in the proper context.
Shift 10 Moves freely from one situation, activity, or aspect of a problem to another as the situation demands makes transitions solves problems flexibly.
Behavioral Shift 5 Adjusts behaviorally to changes in environment or schedule.
Cognitive Shift 5 Problem solves flexibly.
Emotional Control 10 Modulates emotional responses appropriately to situational demand or context.
Monitor 6 Aware of strengths and weaknesses aware of own behavior and impact on others.
Working Memory 12 Holds information in mind for the purpose of completing a task or making the appropriate response stays with, or sticks to, an activity.
Plan/Organize 13 Anticipates future events or consequences uses goals or instructions to guide behavior in context develops or implements appropriate steps ahead of time to carry out an associated task or action.
Organization of Materials 7 Keeps work and school materials organized able to organize environment such as backpack and room.
Task Completion 10 Completes school work or chores in timely fashion finishes tests within time limits works at a satisfactory pace.
58
Internal Consistency
Scale/Index Items a
Inhibit 13 .87
Shift 10 .82
Behavioral Shift 5 .74
Cognitive Shift 5 .72
Emotional Control 10 .86
Monitor 6 .75
Working Memory 12 .86
Plan/Organize 13 .85
Organization of Materials 7 .75
Task Completion 10 .86
Behavioral Regulation Index 39 .93
Metacognition Index 42 .95
Global Executive Composite 81 .96
59
Test-Retest Reliability
Scale/Index ra
Inhibit .77
Shift .71
Behavioral Shift .69
Cognitive Shift .65
Emotional Control .84
Monitor .59
Working Memory .85
Plan/Organize .77
Organization of Materials .79
Task Completion .82
Behavioral Regulation Index .84
Metacognition Index .87
Global Executive Composite (GEC) .89
60
Parent vs Self-Report BRIEF

• Correlations ranged from .25 (Inhibit) to .64
  (Working Memory)
• Parent ratings higher for Metacognition
• Childrens ratings higher for behavioral
  regulation
• Neither Parent nor Child BASC were elevated

61
Parent-Self Correlations for Indexes
BRI MI GEC
Behavioral Regulation Index .52
Metacognition Index .57
Global Executive Composite (GEC) .56
62
Parent Self Reports in Adolescents with ASD
63
Case Examples

• Joshua - 8 year old left handed male,
• Attention Deficit Hyperactivity Disorder,
• Combined Type
• Juan - 12 year old male, Traumatic Brain
• Injury at age 5 years

64
Joshua ADHD - Combined Type
65
(No Transcript)
66
Joshua ADHD - Combined Type
67
(No Transcript)
68
Juan Traumatic Brain Injury
69
(No Transcript)
70
Juan Traumatic Brain Injury
71
(No Transcript)