BRIEF: Behavior Rating Inventory of Executive Function Authors: Gerard A. Gioia, PhD, Peter K. Isqui

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BRIEF Behavior Rating Inventory of Executive
FunctionAuthors Gerard A. Gioia, PhD, Peter
K. Isquith, PhD, Steven C. Guy, PhD, and Lauren
Kenworthy, PhDPublisher Psychological
Assessment Resources, Inc. (PAR)
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BRIEF Authors

• Gerard A. Gioia, Childrens National Medical
  Center
• Peter K. Isquith, Dartmouth Medical School
• Robert M. Roth, Dartmouth Medical School
• Steven C. Guy, Independent Practice
• Lauren Kenworthy, Childrens National Medical
  Center
• Kimberly Andrews Espy, Vice Provost, University
  of Nebraska, Lincoln

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• Overview of the BRIEF

• Purpose Assess impairment of executive function
• For Ages 5-18 years
• Administration Individual, 86 items
• Time 10-15 minutes to administer 15-20 minutes
  to score by hand, software available for
  administration and interpretation

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Overview of the BRIEF

• Utilizes parent and teacher input in the
  evaluation of the childs behavioral functioning
• The BRIEF is useful in evaluating children with a
  wide spectrum of developmental and acquired
  neurological conditions, such as
• Learning disabilities
• Low birth weight
• Attention-deficit/hyperactivity disorder
• Tourette's disorder
• Traumatic brain injury
• Pervasive developmental disorders/autism

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Interest in Executive Function in Children

• 5 articles in 1985
• 14 articles in 1995
• 501 articles in 2005
• Bernstein Waber,
• Executive Function in
• Education, 2007

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Methods of Assessing EF
Macro
Micro
Structural Functional Imaging
Performance Tests
Genetics
Observations
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Measurement of Executive Functions

• Executive functions are dynamic, fluid
• No formal, single test adequate to capture EF
• Many tests are too structured to adequately
  assess EF
• Need intra-individual approach
• Executive is often provided by the examiner

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Limitations of Performance Tests

• EF tests are molar, tapping several EF and non-EF
  functions that can be disrupted in many ways
• Differences in cognitive style or ability can
  affect EF performance regardless of EF
• Sensitivity/Specificity limited- Patients who
  should have EF deficits do well on EF tests EF
  performance not sensitive to frontal vs.
  extra-frontal lesions
• Discriminant Validity- If EF tasks are impaired
  in several disorders, then EFs are not helpful in
  distinguishing between disorders
• Pennington Ozonoff, 1996

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Impetus

• Clinical need for efficient external validation
• Collect standardized observational reports of
  everyday functioning
• Ecological validity, real-world anchor
• Common parent descriptions of everyday executive
  difficulties
• Frustration with available performance tests

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Purpose 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

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Purpose of the BRIEF

• The BRIEF consists of two rating forms
• Parent
• Teacher
• 86 items on both questionnaires

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Additional BRIEF Products

• BRIEF Preschool (Ages 3-5 years)
• BRIEF Self-Report (Ages 13-18 years)
• BRIEF Software (Scoring Reporting)
• BRIEF Adult (Ages 18-90 years)

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A BRIEF Genealogy

• 2000 2003 2004 2005

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Meta- Cognition
Monitor
Org of Materials
Plan/Organize
Working Memory
Initiate
Behavioral Regulation
Emotional Control
Shift
Inhibit
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Behavioral Definitions for the Clinical Scales

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

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Behavioral Definitions for the Clinical Scales

• 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

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Administering the BRIEF Parent Form

• Materials Parent Form and a pen/pencil
• Parent Form is filled out by a parent, preferably
  both parents
• Parent must have recent and extensive contact
  with the child over the past 6 months

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Administering the BRIEF Teacher Form

• Can be filled out by any adult with extended
  contact with the child in an academic setting
  typically a teacher, but an aide is acceptable
• Minimum familiarity is 1 month
• Multiple ratings across classrooms may be useful
  for comparison purposes

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Scoring the BRIEF Parent/Teacher Forms

• Calculate the raw score by adding the circled
  responses to the box for that item
• Sum the scores in each column and record the sum
  in the box for that column
• Transfer the summed scores from page 1 to the
  appropriate box on page 2 and then sum the scores
  for each scale

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Scoring the Negativity Scale

• To score the Negativity scale, find all of the
  N items that were scored a 3
• Sum the number of N items that were scored a 3
  and record that number in the Negativity scale
  box in the Summary Scoring page

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Scoring the Inconsistency Scale

• Scoring the Inconsistency scale is more complex
  and requires greater attention to detail
• Inconsistency items have an I in the margin of
  the scoring sheet
• Transfer the scores for the 10 item pairs to the
  appropriate box on the Scoring Summary page

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Scoring the Inconsistency Scale

• For each item pair, calculate the absolute value
  of the difference for the items
• Then, sum the difference values for the 10 pairs
  to obtain the Inconsistency scale score

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Obtaining Standard Scores for the BRIEF
Parent/Teacher Forms

• Once raw scores for all scales are obtained, find
  the appropriate table in the appendixes
• Tables are broken down by form (Parent/Teacher),
  Age, and Gender of the child
• Standard scores have a mean of 50 and a SD of 10
  percentile ranks also are available in the tables

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Comparison Tables

• Separate normative tables for both the Parent and
  Teacher Forms provide T scores, percentiles, and
  90 confidence intervals for four developmental
  age groups (5-18 years) by gender of the child

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Joshua ADHD - Combined Type
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Computerized Scoring

• BRIEF Software Portfolio (BRIEF-SP) provides
  unlimited scoring and report generation for the
  BRIEF Parent Form, BRIEF Teacher Form, and
  BRIEF-SR, plus Protocol Summary Reports for the
  BRIEF, BRIEF-SR, and BRIEF-P.
• Separate software is available for the BRIEF-P
  and BRIEF-A.

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Interpreting the BRIEF Parent/Teacher Forms

• All results should be viewed in the context of a
  complete evaluation
• High scores do not indicate A Disorder of
  Executive Function
• Problems may be developmental or acquired and,
  thus, are suggestive of differing treatment
  approaches

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Steps to BRIEF Interpretation

• Examine validity scales
• Inconsistency
• Negativity
• Examine clinical scales
• Examine indexes, Global Executive Composite
• Individual item analysis
• Within scale items
• Nonscale items

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Interpretation

• T scores at the Domain level higher scores
  suggesting higher level of dysfunction
• For the Inconsistency scale, look at scores 7 as
  indicating a high degree of inconsistency in
  response by the rater
• A high Negativity scale score indicates the
  degree to which the respondent answers selected
  questions in an unusually negative manner. Is
  information consistent with other sources?

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Interpretive Options

• Professional Manual
• Computer Administration, Scoring and Interpretive
  Report
• Integrated Reporting

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BRIEF Basics
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Reliability

• High internal consistency (a .80-.98)
• Test-retest reliabilityrs .82 for parents and
  .88 for teachers moderate correlations between
  teacher and parent ratings (rs .32-.34)

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Validity

• Convergent validity established with other
  measures inattention, impulsivity, and learning
  skills
• Divergent validity demonstrated against measures
  of emotional and behavioral functioning
• Working Memory and Inhibit scales differentiate
  among ADHD subtypes

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Standardization Population

• Normative data based on child ratings from 1,419
  parents and 720 teachers from rural, suburban,
  and urban areas, reflecting 1999 U.S. Census
  estimates for SES, ethnicity, and gender
  distribution

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Clinical Standardization Population

• Clinical sample included children with
  developmental disorders or acquired neurological
  disorders (e.g., Reading Disorder, ADHD subtypes,
  TBI, Tourette's Disorder, mental retardation,
  localized brain lesions, high functioning autism)

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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

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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

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Case Example

• Joshua
• 8-year-old left-handed male
• Attention Deficit Hyperactivity Disorder,
• Combined Type

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Joshua ADHD - Combined Type
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Joshua ADHD - Combined Type
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BRIEF Clinical Studies

• ADHD - Jarratt et al., 2005 Loftis, 2005
  Viechnicki, 2005 Lawrence et al., 2004
  Blake- Greenberg, 2003 Palencia, 2003 Kenealy,
  2002 Mahone et al., 2002
• Reading Disorders - Gioia et al., 2002 Pratt,
  2000.
• Autism Spectrum Disorders - Gilotty et al., 2002
  Gioia et al., 2002
• Bipolar Disorder vs ADHD - Shear et al., 2002
• Tourettes Syndrome - Mahone et al., 2002
  Cummings et al., 2002
• Traumatic Brain Injury - Landry et al., 2004
  Brookshire et al., 2004 Gioia et al., 2004
  Mangeot et al., 2002 Vriezen et al., 2002
  Jacobs, 2002
• Media Violence Exposure - Kronenberger et al.
  2005
• Spina Bifida and Hydrocephalus - Burmeister et
  al., 2005 Brown, 2005 Mahone et al., 2002.
• Obstructive Sleep Apnea - Beebe, 2004, 2002
• Galactosemia - Antshel et al., 2004
• Childhood onset MS - McCann, et al., 2004
• Sickle Cell - Kral et al., 2004
• 22q11 Deletion - Kiley-Brabeck, 2004
• PKU - Antshel et al., 2003
• Frontal lesions, PKU Hydrocephalus - Anderson
  et al., 2002