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

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


1
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)
2
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

3
  • 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

4
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

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

6
Methods of Assessing EF
Macro
Micro
Structural Functional Imaging
Performance Tests
Genetics
Observations
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

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

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

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

11
Purpose of the BRIEF
  • The BRIEF consists of two rating forms
  • Parent
  • Teacher
  • 86 items on both questionnaires

12
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)

13
A BRIEF Genealogy
  • 2000 2003 2004 2005

14
Meta- Cognition
Monitor
Org of Materials
Plan/Organize
Working Memory
Initiate
Behavioral Regulation
Emotional Control
Shift
Inhibit
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

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

17
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

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

19
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

20
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21
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

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 box on the Scoring Summary page

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

24
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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

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

27
Joshua ADHD - Combined Type
28
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29
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.

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

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

32
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?

33
Interpretive Options
  • Professional Manual
  • Computer Administration, Scoring and Interpretive
    Report
  • Integrated Reporting

34
BRIEF Basics
35
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)

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

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

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)

39
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40
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

41
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

42
Case Example
  • Joshua
  • 8-year-old left-handed male
  • Attention Deficit Hyperactivity Disorder,
  • Combined Type

43
Joshua ADHD - Combined Type
44
Joshua ADHD - Combined Type
45
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46
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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., 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
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