1. BRIEF®: Behavior Rating Inventory of Executive Function® Authors: Gerard A. Gioia, PhD, Peter K. Isquith, PhD, Steven C. Guy, PhD, and Lauren Kenworthy, PhD Publisher: PAR, Inc.

2. BRIEF Authors Gerard A. Gioia, Children’s National Medical Center
Peter K. Isquith, Dartmouth Medical School
Robert M. Roth, Dartmouth Medical School
Steven C. Guy, Independent Practice
Lauren Kenworthy, Children’s National Medical Center
Kimberly Andrews Espy, Vice Provost, University of Nebraska, Lincoln
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3. Overview of the BRIEF Purpose: Assess impairment of executive function
For: Ages 5-18 years
Administration: Individual, 86 items
Time: minutes to administer; minutes to score by hand, software available for scoring and interpretation
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4. Overview of the BRIEF
Utilizes parent and teacher input in the evaluation of the child’s 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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5. 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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6. Methods of Assessing EF
Micro
Macro
Structural &
Functional
Imaging
Genetics
Performance
Tests
Observations
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7. 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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8. 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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9. 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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10. 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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11. Purpose of the BRIEF The BRIEF consists of two rating forms
Parent
Teacher
86 items on both questionnaires
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12. Additional BRIEF Products
BRIEF Preschool (Ages 3-5 years)
BRIEF Self-Report (Ages years)
BRIEF Software (Scoring & Reporting)
BRIEF Adult (Ages years)
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13. A BRIEF Genealogy
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14. Organization of Materials
Meta-
Cognition
Monitor
Organization of Materials
Plan/Organize
Working Memory
Initiate
Behavioral
Regulation
Emotional Control
Shift
Inhibit
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15. 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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16. 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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17. Administering the BRIEF Parent Form
Materials: Parent Form and a pen/pencil
Parent Form is filled out by a parent; preferably, by both parents
Parent must have recent and extensive contact with the child over the past 6 months
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18. 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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19. Scoring the BRIEF Parent/Teacher Forms
Calculate the raw score by transferring 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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21. Scoring the Negativity Scale
To score the Negativity scale, find all of the “N” items that received a score of 3
Sum the number of “N” items that received a score of 3 and record that number in the Negativity scale box in the Scoring Summary/Profile Form
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22. 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 boxes on the Scoring Summary/Profile Form
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23. 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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25. 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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26. 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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27. Joshua
ADHD - Combined Type
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29. Computerized Scoring
BRIEF Software Portfolio (BRIEF-SP) provides unlimited scoring and report generation for the BRIEF Parent Form, the BRIEF Teacher Form, the BRIEF-SR, the BRIEF-P Parent Form, and the BRIEF-P Teacher Form. Three reports are available − an Interpretive Report, a Feedback Report, and a Protocol Summary Report.
Separate software is available for the BRIEF-P only and the BRIEF-A only.
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30. 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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31. 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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32. Interpretation
T scores at the Domain level; higher scores suggest a higher level of dysfunction
For the Inconsistency scale, look at scores ≥7 as indicative of a high degree of inconsistency in rater response
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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33. Interpretive Options Professional Manual
Computer Scoring and Interpretive Reporting
Integrated Reporting
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34. BRIEF Basics BRIEF BRIEF-P BRIEF-SR BRIEF-A Items / Scales 86/8 63/5
80/8
75/9 α s s
Retest s
Inter-rater
Parent – Teacher
r = .30
Parent – Teacher r =
Self – Parent = .50
Self –Teacher = .25
Self–Informant = .64
Covary
BASC, CBCL, ADHD-IV
CBCL,
ADHD-IV
CBCL, BASC, ADHD-IV, CHQ
BDI, FrSBe, DEX, CAD, STAI
Clinical groups
ADHD, LD, TS, ASD, Frontal lesion, PKU,Trauma
ASD, ADHD, Language, LBW
ADHD, ASD, Anx/Dep, DM (T1)
ADHD, MCI, TBI, MS, Epilepsy
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35. Reliability High internal consistency (α = .80-.98)
Test-retest reliability rs = .82 for parents and .88 for teachers; moderate correlations between teacher and parent ratings (rs = )
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36. 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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37. 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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38. 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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40. Diagnostic Group Studies
Reading Disorders
Working Memory: Reading > Controls
Plan/Organize: Reading > 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 > Controls
Initiate & Plan/Org: ELBW > VLBW
G. Taylor, et al.
Mental Retardation
Working Memory: MR > Controls
B. Pratt & T. Chapman
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41. Diagnostic Group Studies
High Functioning Autism
All BRIEF scales: HFA > Controls
R. Landa & M. Goldberg
Pervasive Developmental Disorders
All BRIEF scales: PDD > Controls
L. Kenworthy & S. Guy
Frontal vs. Extrafrontal Lesions
All scales: Frontal & Extrafrontal > Controls
Inhibit: Frontal > Extrafrontal > Controls
R. Jacobs, V. Anderson, & S. Harvey
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42. Case Example Joshua: 8-year-old left-handed male
Attention-Deficit/Hyperactivity Disorder,
Combined Type
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43. Joshua
ADHD - Combined Type
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44. Joshua
ADHD - Combined Type
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47. 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.,
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.
Tourette’s 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
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.
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