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.

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 4/16/2017

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 scoring and interpretation 4/16/2017

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 4/16/2017

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 4/16/2017

Methods of Assessing EF Micro Macro Structural & Functional Imaging Genetics Performance Tests Observations 4/16/2017

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 4/16/2017

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 4/16/2017

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 4/16/2017

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 4/16/2017

Purpose of the BRIEF The BRIEF consists of two rating forms Parent Teacher 86 items on both questionnaires 4/16/2017

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) 4/16/2017

A BRIEF Genealogy 2000 2003 2004 2005 4/16/2017

Organization of Materials Meta- Cognition Monitor Organization of Materials Plan/Organize Working Memory Initiate Behavioral Regulation Emotional Control Shift Inhibit 4/16/2017

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 4/16/2017 5

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 4/16/2017 6

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 4/16/2017

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 4/16/2017

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 4/16/2017

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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 4/16/2017

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 4/16/2017

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 4/16/2017

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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 4/16/2017

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 4/16/2017

Joshua ADHD - Combined Type 4/16/2017

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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. 4/16/2017

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 4/16/2017

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 4/16/2017

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?” 4/16/2017

Interpretive Options Professional Manual Computer Scoring and Interpretive Reporting Integrated Reporting 4/16/2017

BRIEF Basics BRIEF BRIEF-P BRIEF-SR BRIEF-A Items / Scales 86/8 63/5 80/8 75/9 α .80-.90s .93-.98s Retest .94-.96s Inter-rater Parent – Teacher r = .30 Parent – Teacher r = .17 - .28 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 4/16/2017

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 = .32-.34) 4/16/2017

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 4/16/2017

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 4/16/2017

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) 4/16/2017

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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 4/16/2017

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 4/16/2017

Case Example Joshua: 8-year-old left-handed male Attention-Deficit/Hyperactivity Disorder, Combined Type 4/16/2017

Joshua ADHD - Combined Type 4/16/2017

Joshua ADHD - Combined Type 4/16/2017

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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. 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. 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. 4/16/2017