Behavior Rating Inventory of Executive Function BRIEF TM

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. What’s in a name • Children’s 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, Conner’s, 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. 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 Reliability: Internal Consistency

19. Metacognition Behavioral Regulation Global Executive Composite Parent Teacher .96 .98 .96 .97 .98 .98 Reliability: Internal Consistency

20. Scale Initiate Working Memory Plan/Organize Org of Materials Monitor Inhibit Shift Emotional Control Parent Parent Teacher ClinicalNorm 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 Reliability: Test-Retest

21. Metacognition Behavioral Regulation Global Executive Composite Parent Parent Teacher Clinical Norm Norm .83 .88 .90 .80 .84 .92 .81 .86 .91 Reliability: Test-Retest

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 > Inattentive & Controls • MCI: Both ADHD groups > 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 > Controls • Working Memory: Severe > Mild/Moderate > Controls • H. G. Taylor et al. • TS vs ADHD vs TS+ADHD • BRI & MCI: ADHD & TS+ADHD > TS & Controls • E. M. Mahone

27. 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

28. 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

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

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. Or:The 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 preschooler’s behavioral repertoire

49. BRIEF-Preschool Version • Sample: n=450 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